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.
Many patients with CLL have very indolent disease and some will never require therapy in their lifetime. If your patient has a documented slow progression of disease, their CLL care may be returned to you as their Primary Care Provider. Please refer back to Cancer Care Alberta if significant clinical progression is noted that warrants therapy. Please see below for recommendations on when to re-refer.
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.
We recommend laboratory monitoring and physical examination be performed annually and as directed by symptoms.
Potential Symptoms of CLL Progression
Reasons to Re-Refer to the Cancer Centre
Patients should be referred back to their treating oncologist. If the oncologist's contact information is not available, please call the Hematology Triage RN at 403-521-3779 or fax a referral to 403-521-3245.
The table below outlines some common general complications of cancer treatment:
| Complication | Actions |
|---|---|
| Fatigue |
|
| Psychosocial Distress |
|
| Fertility / Sexual Dysfunction |
|
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.
The following resources provide support and information for physicians:
At any time if you have any concerns or are in need of more information please call the Hematology Triage RN at 403-521-3779 or fax a referral to 403-521-3245.
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.
