CLL Support Association
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AlC moving up

Hi Everyone,

Have posted before but still consider myself a newcomer.

Can anyone offer a comment on the following.

Dx in jan.16. ALC 21.15 in mid. Feb. Has gradually moved up since. Has a bout of the flu despite vac. ALC on 22 Aug had gone to 38.11. Because of the flu had new blood test prior to visit to my oncol. Had moved to 43.11 in a week.

My question is it the quantumm of the ALC number or the doubling time ? That is of concern and could the flu have played a part. It took 2 weeks to shake and a double script of Amoxil 875

My oncol. Wants to follow up in a month. I have other symptoms eg glands etc.

Love the help that members offer.

4 Replies

Interested to read your responses cause I could have written this post about me er the flu had to get rid of and glands. No fun at all!



Hi Anne Marie

Because you responded to my earlier post, I have now had a follow up with my Doc. My ALC number has stabilised after a month and remained at 43 Hopefully it has plataued. Will see in 2 months time.

Thanks for your concern. Hope all is well in your home.



The relevant indication for treatment from the iWCLL Guidelines for the Diagnosis and Treatment of CLL, Dec 2008, with my emphasis is:

4. Progressive lymphocytosis with an increase of more than 50% over a 2-month period or lymphocyte doubling time (LDT) of less than 6 months. LDT can be obtained by linear regression extrapolation of absolute lymphocyte counts obtained at intervals of 2 weeks over an observation period of 2 to 3 months. In patients with initial blood lymphocyte counts of less than 30 ϫ 10^9 /L (30 000/uL), LDT should not be used as a single parameter to define a treatment indication. In addition, factors contributing to lymphocytosis or lymphadenopathy other than CLL (e.g, infections) should be excluded.

With regard to your glands (lymph nodes), the relevant indications are:

2. Massive (ie, at least 6 cm below the left costal margin) or progressive or symptomatic splenomegaly

3. Massive nodes (ie, at least 10 cm in longest diameter) or progressive or symptomatic lymphadenopathy

So I'd say, given you've been ill, your recent increase should be ignored. Even if your ALC stays up next reading, it doesn't meet the criteria for starting treatment as (43.11 - 38.11)/38.11 is a 13% increase. Your oncologist is just being cautious by monitoring you more carefully. ALC doubling time is the least important of the reasons to start treatment; provided you remain well and don't meet other criteria for starting treatment, CLL specialists would probably continue to monitor your ALC to see if it plateaus. Some of our members are still in watch and wait with ALCs of well over 200.



Thnks Neill your a legend.



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