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Chronic Lymphocytic Leukemia

Cancer Care Alberta

The evidence-based recommendations described below outline the standard follow-up procedures for Chronic Lymphocytic Leukemia (CLL) surveillance and are intended to assist you in providing optimal cancer follow-up care for your patient; these recommendations are not intended to be a substitute for clinical judgement.

Topics

Surveillance Activities & Timelines|Red Flags|Referrals for Recurrence|Complications & Late Effects of Treatment|Specific Concerns for Patients|General Support for Healthy Living

Quick Reference

Surveillance Activities & Timelines

We recommend laboratory monitoring and physical examination be performed annually and as directed by symptoms.

Red Flags

Potential Symptoms of CLL Progression

  • Rapidly enlarging lymph nodes
  • Unexplained weight loss with or without loss of appetite
  • Unexplained fever
  • Drenching night sweats
  • Progressive, significant cytopenias

Reasons to Re-Refer to the Cancer Centre

  • Progressive and symptomatic lymphadenopathy (documented typically by physical exam, routine radiology imaging for lymphadenopathy is NOT required)
  • Progressive and symptomatic splenomegaly (routine radiology assessment for splenomegaly is NOT required)
  • Progressive cytopenias (typically Hgb ˂110 and/or platelets ˂100)
  • Lymphocyte doubling time of less than 6 months

Note that slow increases in WBC/lymphocytes are a normal part of the natural history of CLL as are the development of small, asymptomatic lymph nodes. These are not indications for treatment or for re-referral.

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Referrals for Recurrence

Patients should be referred back to their treating oncologist. If the oncologist's contact information is not available, please search "leukemia" in the Alberta Referral Directory for the most up-to-date information and instructions for referral.

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Complications & Late Effects of Treatment

The table below outlines some common general complications of cancer treatment:

 
Complication Actions
Fatigue
Psychosocial Distress
  • Increasing helplessness/hopelessness, distress, anxiety or depression may be present
  • Patients experiencing these symptoms should be encouraged to inform their oncology treatment team for appropriate psychosocial referral
Weight Loss
  • Monitor patients who are at risk and refer to a registered dietician as necessary
Fertility / Sexual Dysfunction
 

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Specific Concerns for Chronic Lymphocytic Leukemia Patients

Infection Risk

Patients may be at a higher risk for infections. As such, patients are encouraged to optimize vaccination for COVID-19, influenza, and pneumococcus. Non-live vaccination against shingles should also be considered.

Secondary Malignancy Risk

CLL is associated with a higher risk for secondary malignancies, particularly non-melanoma skin cancers. Annual skin screening and/or referral to dermatology is recommended and a focus on age and risk-factor-appropriate cancer screening.

Cytopenia Risk

CLL is rarely associated with autoimmune hemolytic anemia and/or ITP. Please re-refer urgently in the setting of severe anemia or thrombocytopenia or contact the hematologist on call for advice.

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Note: The information on this page was adapted from the AHS Guideline Resource Unit's Chronic Lymphocytic Leukemia Guideline, and the accompanying Chronic Lymphocytic Leukemia Transfer of Care Physician Letter. Also available is the Chronic Lymphocytic Leukemia Transfer of Care Patient Letter.