Chronic lymphocytic leukemia

Patients not requiring treatment should be monitored with a routine physical exam and complete blood count with differential performed every month for 3 months, then every 3 months, to follow disease progression.​[36]Eichhorst B, Robak T, Montserrat E, et al; ESMO Guidelines Committee. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021 Jan;32(1):23-33. https://www.annalsofoncology.org/article/S0923-7534(20)42469-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/33091559?tool=bestpractice.com [37]Hallek M, Al-Sawaf O. Chronic lymphocytic leukemia: 2022 update on diagnostic and therapeutic procedures. Am J Hematol. 2021 Dec 1;96(12):1679-705. https://onlinelibrary.wiley.com/doi/10.1002/ajh.26367 http://www.ncbi.nlm.nih.gov/pubmed/34625994?tool=bestpractice.com

Routine computed tomography scans are typically not required for diagnosis, staging, or follow-up.[2]Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018 Jun 21;131(25):2745-60. https://ashpublications.org/blood/article/131/25/2745/37141/iwCLL-guidelines-for-diagnosis-indications-for http://www.ncbi.nlm.nih.gov/pubmed/29540348?tool=bestpractice.com [33]National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma [internet publication]. https://www.nccn.org/guidelines/category_1 ​[36]Eichhorst B, Robak T, Montserrat E, et al; ESMO Guidelines Committee. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021 Jan;32(1):23-33. https://www.annalsofoncology.org/article/S0923-7534(20)42469-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/33091559?tool=bestpractice.com [37]Hallek M, Al-Sawaf O. Chronic lymphocytic leukemia: 2022 update on diagnostic and therapeutic procedures. Am J Hematol. 2021 Dec 1;96(12):1679-705. https://onlinelibrary.wiley.com/doi/10.1002/ajh.26367 http://www.ncbi.nlm.nih.gov/pubmed/34625994?tool=bestpractice.com ​​[45]American Society of Hematology. Ten things physicians and patients should question. Choosing Wisely, an initiative of the ABIM Foundation. 2021 [internet pblication]. https://web.archive.org/web/20230316185857/https://www.choosingwisely.org/societies/american-society-of-hematology ​

Monitoring treatment response

The International Workshop on Chronic Lymphocytic Leukemia has developed treatment-response criteria for CLL based on assessment of tumor load, constitutional symptoms, blood count, and bone marrow.[2]Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018 Jun 21;131(25):2745-60. https://ashpublications.org/blood/article/131/25/2745/37141/iwCLL-guidelines-for-diagnosis-indications-for http://www.ncbi.nlm.nih.gov/pubmed/29540348?tool=bestpractice.com See Diagnostic criteria section.

Treatment-response assessment may also include measurable residual disease evaluation (using flow cytometry and next-generation sequencing-based assays), and molecular testing for acquired genetic mutations if there is resistance to treatment. Such analyses are increasingly used in specialist centers. These can be performed on peripheral blood and on bone marrow samples.