Tag Archive for: fevers

What Is Chronic Neutrophilic Leukemia?

What Is Chronic Neutrophilic Leukemia? from Patient Empowerment Network on Vimeo.

Chronic neutrophilic leukemia (CNL) is a rare form of myeloproliferative neoplasm (MPN). Dr. Kristen Pettit from Rogel Cancer Center explains mutations involved in CNL and common CNL symptoms.

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Dr. Kristen Pettit:

Chronic neutrophilic leukemia or CNL is a pretty rare myeloproliferative neoplasm. So when we think of MPNs, we more commonly think of ET, PV, or myelofibrosis but there are a couple of other rare subsets and CNL is one of those. CNL is often driven by slightly different mutations as opposed to PV, ET, or myelofibrosis. One common genetic mutation to see in CNL is involving a gene called CSF-3R.

The actual symptoms of CNL are often similar to what’s in seen in other MPNs. We often see constitutional symptoms like fatigue, fevers, chills, night sweats, those sorts of things. We often see splenomegaly as well, the blood count profile looks a little different in CNL, what we typically see is relatively high white blood cell counts made up mainly of mature neutrophils in that white blood cell differential.

The treatments of CNL are somewhat similar to other MPNs, but maybe a little bit different depending on the specific genetic mutation that’s identified for the individual patient.

MPN Symptom or Treatment Side Effect? Know the Difference

MPN Symptom or Treatment Side Effect? Know the Difference from Patient Empowerment Network on Vimeo.

How do you distinguish MPN symptoms from side effects? Dr. Laura Michaelis explains the difference, and why it’s important to share any changes with your doctor.

Dr. Laura Michaelis is hematologist specializing in myeloproliferative neoplasms (MPNs) at Froedtert & the Medical College of Wisconsin, where she also serves as Associate Professor of Medicine. Learn more about Dr. Michaelis here.

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Dr. Michaelis:             

So, symptoms and side effects are sort of different things. Symptoms are the characteristics of the disease process. And these are things that often can vary in intensity. They maybe accumulate over time. But those are things like, for example, uncontrolled itching, fatigue, night sweats, fevers at night, unintentional weight loss, discomfort in the abdomen, or feeling full shortly after eating. Those are symptoms that often bring patients to the doctor’s attention in the beginning. And those are symptoms that can tell us that the treatments that we’re using aren’t working very well.

Now, side effects is the term that we use for problems that evolve when somebody starts a treatment for a condition. So, for example, if somebody starts the treatment of ruxolitinib for myelofibrosis, it is known that one of the side effects of this treatment is a small but significant lowering in the red blood cell [count].

That is a side effect of the ruxolitinib and should be anticipated. So, before you start the ruxolitinib, your doctor should sit down with you and talk about some of the side effects. And that might be one that gets mentioned.

In addition, we know that there is uncommonly – but uncommonly, people can have, for example, shingles reactivation once they’re taking treatment for myelofibrosis. And that might be something for which you take a prophylactic antiviral treatment.

Hydroxyurea has side effects. Interferon has side effects. And those are things that you should think about before you start them. They shouldn’t be reasons not to start the treatment because most people who take medicines don’t have the side effects. But it is something to keep in mind. And when then occur, report them to your doctor.

So, rarely, there’s conditions that occur, and you’re not sure. Is this a side effect to the treatment? Or does this mean the disease is progressing in some way? That’s one of the reasons it’s important to report all of these conditions to your physician because they need to know.

One of the things that can be helpful is there’s a common tool called the MPN SAF, which is a symptom assessment form.

If, periodically, you and your doctor fill that out during a clinic visit, you can sort of understand are those symptoms that I had with my disease responding to the treatment? Can we really measure that things have gotten better since I started treatment X or treatment Y?

And in addition, when you sit down with your doctor at your regular checkups, it’s not just about going through your blood counts and doing a physical exam. It’s also about telling them what you’ve noticed in the last two to three months since you saw your doctor with regard to the treatments that you’re taking.