Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Management of patients with chronic lymphocytic leukaemia (CLL) in primary care primarily involves supportive care, monitoring for disease progression, infection prevention, and coordination with secondary care haematology specialists. Patients with CLL should be under the care of a haematologist for diagnosis, staging, and treatment decisions, as CLL management often requires specialist interventions such as chemotherapy or immunotherapy NICE NG52.
In primary care, the key roles include:
- Prompt recognition and treatment of infections, as patients with CLL are immunocompromised and at increased risk of infections; broad-spectrum antibiotics should be used according to local protocols, avoiding nephrotoxic agents where possible (e.g., aminoglycosides) Tadmor et al. 2018.
- Monitoring and managing symptoms such as fatigue and lymphadenopathy, and assessing for signs of disease progression or transformation to more aggressive lymphoma, with urgent referral back to haematology if concerns arise NICE NG52.
- Providing vaccinations, including annual influenza and pneumococcal vaccines, to reduce infection risk, as recommended for immunocompromised patients Tadmor et al. 2018.
- Supporting symptom control, including pain management if bone involvement occurs, using appropriate analgesics while avoiding NSAIDs due to renal risk Tadmor et al. 2018.
- Offering psychological support and addressing quality of life issues, including anxiety related to the 'watch and wait' approach often used in early or asymptomatic CLL NICE NG52.
- Facilitating communication and coordination with secondary care, ensuring patients have a named key worker and clear contact pathways for specialist advice and urgent review NICE NG52.
Overall, primary care management of CLL focuses on holistic patient support, infection prevention, symptom monitoring, and timely referral, while active treatment remains the remit of secondary care haematology teams NICE NG52; Tadmor et al. 2018.