My father has Chronic Lymphocytic Leukemia (CLL). He is 53 years of age. He was diagnosed in 1998, and since then his White Blood Cell count has been between 30,000 and 35,000. However, his last blood work test revealed a jump in the count to 46,000. I've researched his form of leukemia and have found him to be either in Stage 0 or 1. The only symptoms seem to be long-lasting infections. He is quite stressed, as one can imagine, and would like to have a few questions answered.
His doctor has told him that if the count reaches 100,000, then is the time to begin treatment.
Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds:
You are obviously very informed about Chronic Lymphocytic Leukemia (CLL) and the risk of progression. The fact that your father has early stage CLL portends for a good prognosis in terms of the possibility of years of not needing treatment. Fortunately many patients with CLL live with the disease form many years and often never develop severe or life threatening complication.
Although the magnitude of the white blood cell count can be scary to some patients and even doctors, in general we do not usually need to treat patients because of a white blood cell count elevation alone. We usually look for other indications prior to making decisions about treatment in this disease.
We usually choose to treat patients with chemotherapy if and when they develop (1) low red blood cell or platelet counts (2) bothersome, dangerous or painful enlarged lymph nodes (3) large liver or spleen (4) bothersome fevers, chills, sweats or night sweats.
With respect to the white blood count, some physicians may choose to treat if the count is doubling rapidly, and at times just on the basis of the high white blood count (definitions of high differ greater than 100,000, 200,000, or 250,000).
Sometimes doctors may choose to give the patient treatments other than chemotherapy for some of these manifestations, such as steroids for a low platelet count or immunoglobulin treatment for frequent infections. Some patients receive radiation therapy for enlarged lymph nodes or large spleen.
We generally have talked about CLL as treatable, because in general we try to just keep the disease under control so that it does not cause any problems. Traditional therapies have not been shown to be able to get rid of the disease. However newer treatments and agents continue to become available and time will tell us if any of these succeed in actually getting rid of the disease in patients; something that would obviously be desirable if we could do so without too much risk or undesirable toxicity.