Signs of Chronic Lymphocytic Leukemia Progression
- Many chronic lymphocytic leukemia (CLL) patients are monitored through a watch‑and‑wait approach. They are monitored for signs of disease progression and not put on active treatment. This may involve going in to be evaluated by a doctor every three or so months, or more often for high-risk patients.
- “I see patients early in the diagnosis a little more often and then depending on the patient, there may be some we only examine twice or three times a year,” Dr. Gary Schiller, of UCLA’s David Geffen School of Medicine, tells SurvivorNet.
- Certain “B symptoms,” such as significant fatigue, fevers, drenching night sweats, and unintentional weight loss, should prompt an earlier call to the care team. These symptoms, along with enlarged lymph nodes or spleen, may signify that the cancer is progressing and treatment may be needed.
Dr. Gary Schiller, director of the Hematologic Malignancy Stem Cell Transplant Program at UCLA’s David Geffen School of Medicine, says it’s key for patients to understand which symptoms warrant a call to the doctor and an earlier visit.
Read MoreThe Symptoms That Should Trigger an Earlier Call
Even patients who are regularly monitored should alert their doctors when new symptoms appear.
“If the patient suddenly became fatigued or started losing weight or developed fever, chills, night sweats to the point that they really have to change whatever they’re wearing at night,” they should contact their medical team, Dr. Schiller says.
“Not just a little dampness like all of us get in a humid summer, but I mean really heavy sweats. Those things could push a button, and we might want to see a patient quickly,” Dr. Schiller adds.
The list of symptoms Dr. Schiller describes are known “B symptoms,” formally defined indicators used to assess disease activity and prognosis in lymphoid cancers, including CLL.
Under the internationally used criteria, B symptoms are specifically defined as:
- Unintentional weight loss of 10% or more within six months
- Fevers above 38.0°C (100.4°F) lasting two weeks or more without evidence of infection
- Drenching night sweats lasting more than a month without evidence of infection
- Significant fatigue affecting a patient’s ability to function
Clinical resources for CLL patients note that the appearance of these symptoms — particularly during a watch-and-wait period — can be a sign that the disease is becoming active and may prompt evaluation for whether treatment should begin.
Additional Signs of Progression
There are some additional signs of CLL progression that some patients may be able to detect, like an enlarged spleen (which can cause a swollen or bloated feeling in the abdomen) or enlarged lymph nodes (which can be felt in the neck or throat area). However, Dr. Schiller points out that most patients are not great at self-examination when it comes to these harder to detect symptoms.
“Some patients are really good at self-examination, and if they notice swollen lymph nodes, then they’ll call. But most patients are not good at self-examination,” he explains.
By outlining specific criteria to look for, Dr. Schiller hopes both patients and their caregivers can better distinguish normal behavior from concerning symptoms and promptly seek help from their CLL care team.
Questions To Ask Your Doctor
- If I’m on watch‑and‑wait, how often should I realistically expect to come in for check‑ups, and what would make you want to see me sooner?
- Which symptoms should I treat as warning signs and address sooner?
- How can I tell the difference between normal changes in my body and signs that my CLL might be becoming more active?
- Should I check for swollen lymph nodes daily or weekly, or would you prefer to evaluate that during appointments?
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