Os pacientes que não necessitam de tratamento devem ser monitorados com exame físico de rotina e hemograma completo com diferencial realizado mensalmente por 3 meses, e depois a cada 3 meses, para acompanhar a progressão da doença.[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
Tomografias computadorizadas de rotina geralmente não são necessárias para diagnóstico, estadiamento ou acompanhamento.[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 publication].
https://web.archive.org/web/20230316185857/https://www.choosingwisely.org/societies/american-society-of-hematology
Monitoramento da resposta ao tratamento
O International Workshop on Chronic Lymphocytic Leukemia desenvolveu critérios de resposta ao tratamento para LLC com base na avaliação da carga tumoral, sintomas constitucionais, hemograma e medula óssea.[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
Consulte a seção Critérios de diagnóstico.
A avaliação da resposta ao tratamento também pode incluir avaliação de doença residual mensurável (usando citometria de fluxo e ensaios baseados em sequenciamento de última geração) e testes moleculares para mutações genéticas adquiridas se houver resistência ao tratamento. Essas análises são cada vez mais utilizadas em centros especializados. Elas podem ser realizadas no sangue periférico e em amostras da medula óssea.