Chronic Lymphocytic Leukemia - The Leukemia & Lymphoma Society

Follow-Up Care. People with CLL need regular medical follow-up after they have
completed treatment. It is important to assess the full effect of therapy as well as to
identify any return of progressive disease that may require additional therapy.
Minimal Residual Disease. Some people with CLL have such a low level of
remaining CLL cells after treatment that these cells cannot be detected by the
usual clinical tests, such as blood and marrow examinations. The term used for
this condition is “minimal residual disease” (MRD). More sensitive tests may be
performed to detect the presence of abnormal cells. The methods generally used to
detect MRD in people with CLL are four-color cell flow cytometry and polymerase
chain reaction (PCR). The benefit of flow cytometry is its widespread reproducible
use that now is standard as part of clinical trials. These techniques may provide
information that can help the doctor to recognize a disease relapse and to start
treatment again. However, treating asymptomatic patients with MRD remains a
research question and should not be pursued outside of clinical trials.
People who have been treated for CLL and/or other cancers are encouraged to keep
a record of the treatments they have received. It is a good idea to share these records
with the doctors who monitor general health problems, both during treatment and
after treatment ends. Regular screening and monitoring for skin, colorectal, breast
and other types of cancer is advisable.
Related Diseases
The diseases mentioned in this section result from the cancerous transformation of
a type of lymphocyte; the accumulation of these cancer cells occurs mainly in the
marrow, the blood and the spleen (see Table 5 on page 25).
There are distinguishing characteristics that enable the hematology oncologist
to identify each disease, including the appearance and the immunophenotype
of the cancer cells; the cells’ varying effects on normal marrow and blood cell
development; and the cells’ varying effects on other parts of the body, such as the
kidneys, bowels and nervous system.
The diseases represent a range of clinical severity. At one end of the range, there are
the diseases that may be stable and may not advance in severity for some months or
years, or occasionally indefinitely. At the other end of the range, there are diseases
associated with difficulties that may be present at diagnosis and possibly get worse,
requiring immediate treatment and frequent observation.
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