CLL

My mum is 74. She is diagnoised with chronic lymphetic leukemia (stage 2)  in April 2000.   Her white blood count has risen to 125 last week. Her lymphocyte count is 108.  However, she is not prescribed with any medication.  The doctor said medication is not required at this stage.  I would like to know when will they start considering treatment for my mum?  

[Fernando Roque, MD]

Hi.  The National Comprehensive Cancer Network (NCCN) guidelines indicate that treatment for chronic lymphocytic leukemia be started under the following conditions:

1.  The patient has decreased red cell or platelet counts because of immune-mediated processes induced by the CLL (these conditions include autoimmune hemolytic anemia, pure red cell aplasia, and immune thrombocytopenic purpura)
2.  Recurrent infections
3.  Bulky disease (this can be determined by doing imaging studies like CT or indirectly by testing for serum lactate dehydrogenase or LDH.  A very high LDH value would mean bulky disease)
4.  Transformation of the CLL into either Hodgkin's lymphoma or Diffuse Large B-Cell Lymphoma

The absolute value of the white cell count is not a criteria for initiating treatment.