Personalized Selection of Upfront Therapy in CLL - Episode 1

Diagnosing Chronic Lymphocytic Leukemia

Javier Pinilla-Ibarz, MD, PhD: Chronic lymphocytic leukemia is the most common leukemia in the Western world. It is very likely seen in patients over 70 years of age, affecting like a high proportion of patients in this age population. You can argue it is around 0.6 of the whole population, but definitely when people are over 70, 75, they have a high probability to have, if not the leukemia, some clones that will really become truly a stage 0 chronic lymphocytic leukemia.

In the last year, we have much more information, and thanks to the research that has been done in the physiopathology of CLL, we start to really have some clues about how and when this disease arises. However, there still are a lot of unknowns, right? So, we know there are certain genetic defects, chromosomal abnormalities that may really happen in patients who have this leukemia. And there have been some polymorphisms reported in certain genes that may really also have a predisposition in the onset of this condition in the older age.

In terms of diagnosis of chronic lymphocytic leukemia, very often we encounter patients who really see their regular physician once a year and they have blood counts performed at the physician office. This is one of the most common scenarios where people can really see a high amount of excessive lymphocytes, which really prompt a further workup and, of course, a referral to a hematologist or a hematology oncologist who will really perform further tests and will diagnose the condition. But I think the point I’m making here is that most of the cases, if not a very, very high proportion of patients, they are completely asymptomatic at presentation and they are really, really surprised when the doctor tells them they have a chronic leukemia condition.