Ask the Doctor Question:
I was diagnosed with CLL four years ago. My WBC has gradually increased to 40 as of April of 2021, and just recently had increased to 70 as of September. The oncologist I’m seeing is not aware of this new reading yet since the blood work was from my annual physical. The oncologist has never given me a number that she’s looking for to begin any treatment and I’m wondering if 70 is considered a critical number to start? I’m 64 and my health is generally very good.
Answer: If you haven’t already, please see this article on our website which discusses reasons to start treatment when you are in the Watch and Wait phase. https://cllsociety.org/2016/03/cll-watch-wait-start-treatment/.
The decision to start therapy in CLL is almost never guided by an increase in any one lab result. It is more of the trend over time. He/she will also be looking at your absolute lymphocyte count (ALC) and how it is trending over time. Many of our patients find it helpful to use our lab trending tool where you can enter your lab values and watch them trend over time in one place. That can be found on our website here: https://cllsociety.org/toolbox/keeping-track-of-lab-results/.
Please share your lab results with your CLL Specialist as soon as you can and have a discussion about what his/her threshold is for initiating a new therapy. The good news is that it sounds like you are having no other “B Symptoms” which would indicate it is time for treatment. Additionally, remember it is essential that you obtain FISH testing prior to the initiation of any new therapies. You can find more information on that here: https://cllsociety.org/docs/CLL%20ToolKIT%20Test%20Before%20Treat%20Page%20v1R1%20012321_Updated%20PO%20Box.pdf