How Do You Know When CLL Treatment Should Begin?

Our recent CLL Global Research Foundation virtual town hall featured CLL Global President, Dr. William Wierda, and Dr. Patrick Reville, Assistant Professor in the Department of Leukemia at The University of Texas MD Anderson Cancer Center. CLL patient advocate Jeff Folloder moderated the event. Watch the full webinar.

Transcript

Jeff Folloder:

Dr. Reville, I have a question that’s come in regarding watch and wait, or as us patients call it, watch and worry because no matter what you guys tell us, we’re still going to worry when we’re doing nothing. We know we’re doing something, but it just doesn’t feel good.

When they’re in watch and wait, when a patient is being observed, what white blood cell count elevation would prompt a therapy, or is it just the WBC that does that?

Dr. Patrick Reville:

Yes, so actually the white blood cell count by itself is usually not the main reason that we would think about initiating treatments. And so the white blood cell count all on its own can actually get very high before it would ever cause any significant problems on its own. And so the mainstay, really, of thinking about treatment initiation, and there’s clear sort of guidance on this in different settings. But it’s mainly based on symptoms.

So, how patients are feeling I think is really the biggest consideration. So, the numbers, especially the white blood cell count all by itself, is usually not something that I am looking at as sort of the immediate decision point to start treatment. There are other blood counts that we’re looking at. In particular, we look at sort of the red blood cell indices and the hemoglobin or the platelet count, which are kind of the other two major blood components.

So, if we start to see issues with those, in particular those going down, that could be a sign that the CLL is starting to disrupt the way that the normal blood system is being formed, and so that might be an indication for starting treatment.

And then I think lastly is around lymph nodes. And so lymph nodes that are getting large, growing rapidly.

Or again, coming back to the symptom piece, lymph nodes that are starting to cause symptoms or starting to impede on the function of sort of other organs or other things there. That would be another reason.

So, the white blood cell count is a piece of that, and we do look at that as we’re investigating, but that all by itself is not usually the sole determinant for starting treatment for patients.