Treatment outcomes for people with CLL vary widely, and expected outcomes are influenced by the
- Stage of the disease
- Presence or lack of various factors associated with higher-risk disease
- Overall health of the patient
- Other considerations.
Current research suggests that newer treatment combinations and approaches may improve the length of survival. People with CLL should consult with their doctors to discuss individual potential outcomes. For survival statistics, click here.
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 bone marrow examinations. This is called “minimal residual disease (MRD).” More sensitive tests may be performed to detect the presence of abnormal cells, such as multicolor cell flow cytometry and polymerase chain reaction (PCR).
Having a negative MRD status after the end of treatment is emerging as an important factor that can predict the effectiveness of the treatment received. In addition, assessing MRD status can provide information to help the doctor recognize a disease relapse and decide if the continuation of treatment is necessary.
Responses to CLL Treatment
People with chronic lymphocytic leukemia (CLL) have a range of responses after treatment. The table below describes the criteria for various types of CLL treatment responses. Stavle disease is the absence of progressive disease (PD) and the failure to acheive at least a partial response (PR).
|Group||Parameter||CR (Complete Response)||PR (Partial Response)||PD (Progressive Disease|
|Lymph nodes||None ≥ 1.5 cm||Decrease ≥ 50% from baseline||Increase ≥ 50% from baseline or from response|
|Liver and/or spleen size (spleen size considered normal if < 13 cm)||Spleen size < 13 cm; liver size normal||Decrease ≥ 50% from baseline||Increase ≥ 50% from baseline or initial response|
|Circulating lymphocyte count||Normal||Decrease ≥ 50% from baseline||Increase ≥ 50% from baseline|
|Platelet count||≥ 100,000/µL||≥ 100,000/µL or increase ≥ 50% from baseline||Decrease ≥ 50% from baseline secondary to CLL*|
|Hemoglobin||≥ 11.0 g/dL (untransfused
and without erythropoietin)
|≥ 11.0 g/dL or increase ≥ 50% from baseline||Decrease ≥ 2 g/dL from baseline secondary to CLL*|
|Marrow||Normocellular, no CLL cells, no B– lymphoid nodules||Presence of CLL cells or B–lymphoid nodules, or test was not done||Increase ≥ 50% in CLL cells based on successive biopsies|
Abbreviations and qualifications: CR, complete response (all of the criteria have to be met); PR, partial response (at least 1 of the parameters of group A and 1 of group B needs to improve if previously abnormal; if only 1 parameter of both groups A and B are abnormal prior to therapy, only 1 needs to improve); PD, progressive disease (at least 1 of the criteria of group A or group B has to be met; constitutional symptoms alone do not indicate PD).
*“Secondary to CLL” means that this decrease in platelets or hemoglobin is due to the CLL and not from something else (for example, autoimmune disorder, treatment, etc.).
Source: Hallek M, Cheson BD, Catovsky D et al, iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018; 31(25):2745-2760.
- Download or order The Leukemia & Lymphoma Society's free booklet, Chronic Lymphocytic Leukemia.