What Is Watch and Wait in CLL?

What is Watch and Wait in CLL? from Patient Empowerment Network on Vimeo.

Chronic lymphocytic leukemia (CLL) patients often experience watch and wait, but what is it? Watch to learn about watch and wait and what CLL patients can expect during this period.

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Transcript:

Chronic lymphocytic leukemia (CLL) patients will often have a period of monitoring called watch and wait. Watch and wait is also known as watchful waiting or active surveillance. During watch and wait, CLL care providers check blood counts and perform medical examinations on a regular basis to gauge whether any disease progression of concern occurs.

One of the reasons that CLL is sometimes referred to as a “good cancer” is due to the fact that many CLL patients remain in watch and wait for a period of years rather than months. Though some CLL patients refer to watch and wait as “watch and worry,” CLL research has proven active surveillance as optimal for some CLL disease states. This strategy of watch and wait is the standard of care when a patient experiences no symptoms and only has small changes in blood counts.

Brian Hill, MD, PhD:

“We’re taught in much of medicine and in much of cancer that early diagnosis and early treatment is very important. And it is very important for many conditions – breast cancer or we’re taught let’s get our mammograms.

And have an early detection and immediate treatment to cure breast cancer. Similarly, colon cancer – get your colonoscopy, get your diagnosis sooner rather than later. And have surgery so you can have a higher likelihood of a cure. In the case of chronic lymphocytic leukemia, it’s never been shown despite multiple attempts over many decades, that treating someone with CLL is – earlier, is going to impact the outcomes and the big picture. But we do know that treating CLL earlier can lead to more side effects earlier.

So, in other words, if you feel fine and your blood counts are just a little abnormal, and there’s not compelling indication to treat, we can safely observe patients until an indication for treatment exists.”

CLL care providers will monitor blood counts and symptoms carefully to determine when a patient should move from watch and wait to active treatment.

What is the Prognosis of CLL?

What is the Prognosis of CLL? from Patient Empowerment Network on Vimeo.

Chronic lymphocytic leukemia (CLL) can progress in two different ways. Watch to learn about the prognosis, monitoring, and treatment for each CLL type.

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Transcript:

Chronic lymphocytic leukemia (CLL) patients generally have a better outlook compared to other cancer types – with a higher 5-year survival rate of about 83 percent. There are two types of CLL – one being a slower-growing type and the other a faster-growing type. 

The slower-growing type features higher lymphocytes with slightly low platelets, neutrophils, and red cells. While the faster-growing type produces too many CLL cells in the blood that prevent proper function of red cells and platelets. With the two different types of CLL, patients may have very different patient journeys depending on their disease 

While some CLL patients experience very gradual disease progression and are actively monitored during a watch-and-wait phase, other patients may experience a more expedited CLL progression and will need more frequent treatment. 

Dr. Kerry Rogers:                 

“So, for many people, CLL is a very manageable disease. Like I said, some people have had CLL longer than I’ve been a doctor and have needed no treatment for it. However, there are people with CLL that go on to have a lot of difficulty from it, including not doing well with more than therapy or needing really new, advanced therapies, like something called CAR T-cell therapy.

So, for any individual person, you can never say how it’s gonna turn out for them, but we do use our experience taking care of lots of people with CLL to make an educated guess as to if this person’s gonna be someone that’s gonna expect to need a lot of treatment in their lifetime, or maybe no treatment in their lifetime.”

CLL research continues to advance, and clinical trials bring more refined treatments for patients to improve both CLL symptoms and treatment side effects over time. Ask your CLL specialist if you have questions about research advances and check reliable sources like the Patient Empowerment Network, The Leukemia & Lymphoma Society (LLS), and the American Society of Hematology (ASH) and American Society of Clinical Oncology (ASCO) annual conferences.

How Is Flow Cytometry Used in CLL?

How is Flow Cytometry Used in CLL? from Patient Empowerment Network on Vimeo.

Chronic lymphocytic leukemia uses flow cytometry as part of testing methods, but how is it used? Watch to learn about the information provided by flow cytometry tests and how the information is used for CLL patients.

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Transcript:

Chronic lymphocytic leukemia (CLL) can be either a slower-growing or faster-growing type depending on the patient. There are several tests that CLL specialists use in diagnosing the condition – with flow cytometry being one of the testing tools.

Flow cytometry provides information about particle or cell characteristics including:

  • DNA gene expression
  • Total DNA
  • Cell structure
  • Cell size
  • Newly-created DNA
  • Amount and type of specific surface receptors
  • Intracellular proteins
  • Transient signaling

Dr. Lyndsey Roeker:                

“So, at diagnosis flow cytometry is the first test done, and what that means is, you take all of your white blood cells in your blood, and you run them through a fancy machine that puts them into buckets. So, you have a bucket of your normal neutrophils, a bucket of your normal lymphocytes, and then you find this bucket of cells that look somewhat unusual. And those have a specific look, if you will, and if they look like CLL cells, that’s how we make the diagnosis.”

The properties found in flow cytometry help to determine the type of CLL that a patient has. CLL specialists then use flow cytometry results along with other blood tests, a patient’s medical history, and other signs and symptoms to establish CLL prognosis and treatment options. Flow cytometry is a key test that confirms CLL diagnosis by checking a patient’s bone marrow or blood cells for signs of CLL, and test results are used to help determine optimal care for each patient.

What Is Chronic Lymphocytic Leukemia (CLL)?

What is Chronic Lymphocytic Leukemia (CLL)? from Patient Empowerment Network on Vimeo.

CLL stands for chronic lymphocytic leukemia, but what is it exactly? Watch to learn how CLL develops and hear from CLL expert Dr. Jennifer Woyach and patient Adrian.

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Transcript:

CLL is a blood cancer called chronic lymphocytic leukemia, which originates in the bone marrow of patients. Genetic mutations in the blood become leukemic, multiply into CLL cells, and bring on the condition of CLL. CLL is counted as the most common adult leukemia type among countries in the Western world. For the most part, CLL impacts older adults at an average diagnosis of age 70 with slightly more men impacted compared to women with CLL.

Dr. Jennifer Woyach:

“CLL is an interesting disease because it’s one of the only cancers that does not require a biopsy of something for a diagnosis. So, we can, actually, make the diagnosis of CLL based on the peripheral blood.”

Adrian (CLL Survivor): “It happened as a bit of a shock to me, actually. I’ve been quite healthy quite well earlier that week. I’d gone walking in the mountains in Switzerland, but I collapsed one day on the way home from work, and was diagnosed with pneumonia. And during that illness, they realized that my immune system wasn’t working too well, and then my lymphocyte count was high, and I was diagnosed with CLL. I was put on watch and wait, which for some people can last a decade or more, but for me, it only lasted 15 months.”

Sometimes referred to as a “good” cancer among cancer types, many CLL patients stay in an active surveillance period of “watch and wait” for several years.

What Is CD5 Expression in CLL?

What is CD5 expression in CLL? from Patient Empowerment Network on Vimeo.

Chronic lymphocytic leukemia (CLL) patients display a different CD5 expression than some other blood cancers. Watch to learn about CD5 expression and how monitoring plays into CLL patient care.

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Transcript:

The protein of CD5 is abnormally expressed (or displayed) in T cells and/or in B-1a B cells in chronic lymphocytic leukemia (CLL) and is often referred to as a marker. The small CD5-positive B lymphocytes multiply and accumulate in a CLL patient’s blood, bone marrow, and secondary lymphoid tissues and then create the condition of CLL. Though some blood cancers show as CD5-negative status, CD5 is shown as overexpressed along with CD19 and CD23 combined with weak expression of CD20 and CD79b in CLL patients.

Recent research studies looking at different CD markers including CD5 show that monitoring of CD expression changes over time can help more accurately determine prognosis for CLL patients. 

Dr. Jennifer Woyach:

“So, there is kind of a code of these markers on the surface of all of your blood cells that can tell what type of cells they are. So, for CLL in particular, we’ll see that the cells express some of the normal markers we would see on a normal B lymphocyte.

Things like CD19, CD20, CD23. But they also express a marker called CD5, which is found on normal T lymphocytes but shouldn’t be found on B lymphocytes.

And so, this collection of surface markers can make the diagnosis of CLL. Sometimes, we do need to do extra studies like a bone marrow biopsy or a lymph node biopsy. But oftentimes, those are not necessary at the time of diagnosis.”

As always, check with your CLL specialist if you have more questions about CD5 expression in CLL.

How Is CLL Staged?

How is CLL staged? from Patient Empowerment Network on Vimeo.

Chronic lymphocytic leukemia has various methods of staging, but what are they? Watch to learn the different methods that are used for CLL staging and how CLL risk is determined.

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Transcript:

Chronic lymphocytic leukemia (CLL) specialists have used three different staging systems to assist them in forecasting disease progression and creating suitable treatment plans for patients. Depending on where or when a CLL patient has been diagnosed and monitored, their specialist(s) may have used the Rai staging system, Binet staging system, and/or CLL International Prognostic Index (CLL-IPI).

Dr. Kerry Rogers:

“So, unlike most cancers, where CLL is staged with CT scans or PET scans, the staging for CLL is actually remarkably simple, and I really like this because it limits the amount of testing you have to do for people, especially the people that might be just monitored for their CLL or observed. You don’t wanna put them through a lot of intensive testing they don’t need. So, the only two things you need to properly stage CLL are a complete blood count and a good physical exam.”

The Rai staging system uses the three stages of low risk, intermediate risk, and high risk to categorize patients. While the Binet staging system uses the three stages of A stage, B stage, and C stage.

 In 2016, the CLL-IPI staging system was initiated worldwide to provide a unified staging system for CLL patients. 

In CLL-IPI staging, the following prognostic factors were identified, including:

  • TP53 deleted or mutated – assigned 4 points
  • Unmutated IGHV – assigned 2 points
  • Serum beta-2 microglobulin concentration greater than 3.5 mg/L – assigned 2 points
  • Rai Stage I – V or Binet Stage B – C – assigned 1 point
  • Patient age over 65 years – assigned 1 point

The point totals from the five factors in CLL-IPI staging correspond to the following recommendations:

  • Low risk – 0 to 1 point; no need to treat
  • Intermediate risk – 2 to 3 points; no need to treat unless the patient is highly symptomatic
  • High risk – 4 to 6 points; treatment unless the patient experiences no symptoms
  • Very high risk – 7 to 10 points; If the decision is made to treat, use novel agents or treatment in a clinical trial instead of chemotherapy