flow cytometry is showing about 74% CLL involvement.

[juniper1975]

Is it likely that treatment might be needed in the near future? Husband is trisomy 12, TP53 negative. Mutated. He has splenomegaly, and enlarged nodes.

Fish is in process.

INTERPRETATION

A phenotypically abnormal population with forward and right-angle scatter features of small lymphocytes constitutes 74% of analyzed events. It dimly expresses the B-cell associated antigens CD19, CD20, CD22 and low intensity monoclonal surface immunoglobulin of kappa isotype. In addition, it expresses CD5 and CD23, but does not express CD10. <1% of the abnormal cells express CD38, which is considered negative.

The remaining cells are a mixture of lymphoid, monocytic, and mature myeloid cells. Granulocytes and monocytes are normal in proportion and have a nomal immunophenotype. The T-cells constitute 6% of the analyzed events and show a CD4:CD8 ratio of 1:1. There is no significant loss of pan-T-cell antigens noted. NK-cells are normal in proportion and show a normal phenotype.

Can anyone give insight please?

He was diagnosed 14 years ago next month, and has been very indolent. Just wondering if these results show anything other than an indolent case of CLL?

Thank you!

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[SofiaDeo]

IMO it's impossible to hazard a guess based on a fragmented data part of a patients chart, it's difficult to extract meaning without more context/information. Since Trisomy 12 and noting the absence of a TP53 deletion is part of a FISH, I am unsure why you state it's "in process". Also, splenomegaly and enlarged nodes need more information, like size and if symptoms are present, in determining how significant they are.

[bennevisplace]

The data you've posted give a snapshot of what's going on in the blood, and characterise the CLL cells. More data would be useful.

Full Blood Count history, including absolute counts. Also qs. from Sofia.

The FBC trend may confirm progression as "indolent" in terms of peripheral blood values. But if CLL cells have been accumulating in lymph nodes and spleen in preference to bloodstream, you may be looking at more of a SLL presentation rather than CLL. And if the spleen and/ or lymph nodes are sufficiently enlarged, your husband's specialist may consider that a trigger for treatment, despite a low lymphocyte count in peripheral blood.

Symptomatic or progressive CLL as defined by the International Workshop on Chronic Lymphocytic Leukemia includes:

Massive (i.e., ≥6 cm below the left costal margin), progressive, or symptomatic splenomegaly.

Massive nodes (i.e., ≥10 cm in longest diameter), progressive, or symptomatic lymphadenopathy.

cancer.gov/types/leukemia/h...

[juniper1975 in reply to bennevisplace]

His spleen is 19cm. A recent ultrasound of his neck(regarding large thyroid nodule) shows several enlarged nodes.

Here are the details of his last lab work. Flow symmetry above. Blood counts below.

WBC 31

HGB 16.8

HCT 51

MCV 93

RDWCV 13.5

PLT 130.. last month after a surgery it was 100

Smear…there is an atypical monotonous lymphocytosis composed of small lymphocytes with clumped chromatin and scant cytoplasm. Numerous smudge cells are seen.

In his labwork listed last week, I am pretty sure I saw Fish request in last week’s blood draw. In the note from his oncologist yesterday, it says FISH CLL and chromosome analysis test added to the blood drawn last week. I suspect they are redoing FISH to clarify results perhaps?

Flow symmetry

[bennevisplace in reply to juniper1975]

Thanks, do you also have the absolute lymphocyte and neutrophil counts?

The chart you screenshot is headed Flow symmetry, which must be the dark force autocorrecting Flow cytometry 🙂 I'll let more learned contributors analyse those data.

[juniper1975 in reply to bennevisplace]

Neutrophil 13.5%…neutrophil count 4.2x10^9/L…..lymphocyte count 26.3x10^9/L(atypical lymphocytes with clumped chromatin and prominent nucleoli)….lymphocyte 84.6%

I so appreciate any information or explanation. You are so kind to explain this all to me!

[SofiaDeo in reply to juniper1975]

This is the most unusual labwork I have ever seen, I am unfamiliar with any tests giving exactly the data you reported.

[juniper1975 in reply to SofiaDeo]

I am so puzzled as I don’t understand any of it, for the most part.

[bennevisplace]

His blood values look great 14 years after diagnosis. Haemoglobin and neutrophils in normal range, platelets only slightly below, lymphocytes only 26 x 10^9/ L, all indicative of a slow progression.

I'm not the one to comment on haematocrit, mean cell volume and red cell width variation values, but I believe these are routine blood analyses. The first two seem to be in normal range, though the units for HCT don't gel with qehbpathology.uk/images/fil...

Enlarged lymph nodes sometimes warrant a node biopsy. Has this been mentioned?

[juniper1975]

No biopsies have ever been mentioned. Maybe I will get more information when FISH and the chromosome analysis come back.

I am so appreciative of your input! Thank you!

[lankisterguy Volunteer]

Hi juniper1975,

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We have several past postings that may be useful for you to read.

But to respond to your original post text first- the blood tests you posted generally point to a very slow progression over 14 years, the 74% is not a very useful data point- his ALC / Lymph# lymphocyte count 26.3x10^9/L- and his ANC / Neut# Neutrophil is what you should be tracking instead. If those are not changing much, then all the blood tests on the white cells ( your original post text is all about white cells) probably won't predict his need for treatment.

But CLL has many different drivers for starting treatment, and I agree with bennevisplace , you will likely want to watch his Red Blood tests eg: HGB 16.8, HCT 51, MCV 93, RDWCV 13.5, PLT 130. and his ANC Neut#. If his bone marrow gets crowded these will start dropping quickly.

Another significant driver to treatment is enlarged nodes and spleen, some CLL patients have all their disease show up in those and not in the blood.

Here is a link to one of our pinned posts with a number of CLL experts explaining how they determine when to start treatment.

healthunlocked.com/cllsuppo...

And the replies to this recent posting may be useful for you:

healthunlocked.com/cllsuppo...

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Len

[juniper1975 in reply to lankisterguy]

Thank you, Len. This is very useful.

[JustAGuy]

How is he feeling? That can also be part of the equation.

[juniper1975 in reply to JustAGuy]

Pretty good for the most part. The usual fatigue upon occasion. Definitely had secondary cancers. Numerous squamous cell carcinomas, and a very rare malignant gist. Meeting with an endocrinologist next month, as thyroid has large nodule, and T4 is out of whack.