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Treatment of Chronic Lymphocytic Leukemia

Follow-up

After treatment is finished, a formalized evaluation of the treatment response should be performed based on NCI criteria. As a minimum, this involves a complete clinical examination with emphasis on lymph nodes, the liver, and spleen.

Determination of hemoglobin, leukocytes, granulocytes, lymphocytes, and thrombocytes in blood should be done a few weeks after concluded treatment. Additionally, a bone marrow examination should be performed, preferably with both aspirate and biopsy.

Response criteria (NCI)
Criterion Complete response Partial response Progressive disease
Symptoms None               None  
Lymph nodes Nodes > 50% reduction > 50% increase or new manifestations
Liver/spleen Not palpable > 50% reduction > 50% increase or new manifestations
Hemoglobin > 11 g/dl

> 11 g/dl or 50% improvement

 
Granulocytes > 1,5 x 109/l > 1,5 x 109/l or 50 % improvement  
Lymfocytes < 4 x 109/l > 50% reduction

> 50 % increase

Thrombocytes > 100 X 109/l >100 x 109/l or 50% improvement  
BM-aspirate < 30 % lymfocytes    
BM-biopsy No infiltrates Nodular infiltrates  

Some doctors will also include a CT of the abdomen and thorax in this type of response evaluation, but outside of clinical studies, the clinical benefit to be obtained from these procedures is doubtful.

Thereafter, the patient is checked at regular intervals (individually adapted) with patient history, clinical examination, and certain laboratory parameters as mentioned above.

The indication for re-treating will usually be the same as for primary treatment.

Transformation to aggressive B-cell lymphoma (Richter's syndrome)

Some patients with chronic lymphocytic leukemia over years exhibit an increasing number of promyelocytes with declining treatment response. This is not actually a transformation, but a more rapid selection of clones over time which is less sensitive to treatment. Richter's syndrome occurs in 3-5% of patients with chronic lymphatic leukemia. The disease profile is characterized by rapid growth of one or more lymph nodes accompanied by systemic manifestations such as fever and/or weight loss. A histological examination of the affected lymph node is similar to that of large-cell B-cell lymphoma.

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