The Initial Approach to Patients with Chronic Lymphocytic Leukemia Diagnosed in Day-to-Day Practice

Abstract

SUMMARY As chronic lymphocytic leukemia (CLL) research increases and new technologies and drugs become available, the landscape of this disease becomes more complex. It is this complexity that suggests the use of practical recommendations in day-to-day practice. The close relationship between early CLL and clinical monoclonal B lymphocytosis regarding clinically relevant parameters does not provide evidence to strictly separate these entities by a distinct threshold of clonal B cells. Prognostic testing and staging procedures based on costs and logistics should be favored at diagnosis, while assessment of more specific markers predicting treatment-related outcome (i.e., 17p del/P53 mutation) should be reserved to patients for whom treatment is required. A diagnosis of CLL, especially in younger patients (<55 years), may cause a number of fears and worries with regard to the course–outcome of the disease. Therefore, communication between the patient and doctor should be informative with respect to the impact of disease on the patient’s affective, social and economic spheres. Finally, current available guidelines should drive the choices of physicians who currently treat CLL patients, with room allowed for consideration of emerging new evidence, physician practice style, patient preference, clinical judgment and patient quality of life. Doctors should also keep in mind that people with CLL want to live their lives as normally as possible; therefore, every effort should be made to ensure the achievement of this goal.