What are the current guidelines for the initial management of a patient diagnosed with Chronic Lymphocytic Leukaemia (CLL)?

For the initial management of a patient diagnosed with Chronic Lymphocytic Leukaemia (CLL), the provided UK guidelines from NICE and CKS primarily focus on the recognition and referral of suspected haematological cancers, rather than the specific initial management of a confirmed CLL diagnosis ¹,². However, international clinical guidelines, such as those from the Grupo Español de Leucemia Linfocítica Crónica and the French CLL Study Group (FILO), provide detailed recommendations for initial management ((García-Marco et al., 2017), (Quinquenel et al., 2020)).

A common initial approach for many patients with CLL, particularly those who are asymptomatic, is 'watch and wait' (observation without therapy) ((García-Marco et al., 2017), (Quinquenel et al., 2020)). This strategy is also considered for other clinically non-progressive low-grade non-Hodgkin's lymphomas where treatment is unlikely to result in vital organ dysfunction and the patient is asymptomatic ¹. During this period, patients are closely monitored for disease progression or the development of symptoms that would necessitate active treatment ((García-Marco et al., 2017), (Quinquenel et al., 2020)).

Active treatment is typically initiated when patients develop specific indications, such as significant symptoms, progressive lymphadenopathy or splenomegaly, cytopenias (anaemia or thrombocytopenia) due to bone marrow failure, or other signs of active disease ((García-Marco et al., 2017), (Quinquenel et al., 2020)).

Supportive care is also a crucial aspect of initial management, including the prevention and management of infectious complications, which are common in CLL patients ((Mikulska et al., 2024)). Patients with confirmed haematological cancers like CLL are managed in secondary care by a haematologist and a multidisciplinary team ³. General practice plays a role in supporting these patients, including prompt treatment of infections, pain assessment, ensuring vaccinations (influenza, pneumococcal), and providing advice on lifestyle and identifying new symptoms ³. Communication with the patient and their family about the disease, treatment, and potential late effects is also important ¹. If 'watch and wait' is advised, it is essential to explain what this involves and address any associated anxiety ¹.