Complete Remission

[leftysfsl1945]

My Complete Blood Count (CBC) results state the normal range for Lymphocytes is 850-3900 cells/uL.

The NCCN CLL guidelines for Complete Remission (CR) states Lymphocytes must be less than

5000 cells/uL.

Why is 5000 cells/uL an acceptable NCCN CLL CR level for Lymphocytes when the maximum for the Complete Blood Count is 3900 cells/uL?

[AussieNeil Partner Administrator]

Hi Leftysfsl1945,

What NCCN guidelines are you using? The latest version 3.2024, states that for a Complete Response, the circulating lymphocyte count must be normal, that is under 3,900 cells/uL for your pathology lab. The limit varies by lab - mine uses a limit of 3,500 cells/uL. The 5,000 count is the threshold for a diagnosis of CLL as opposed to SLL or MBL. "CLL diagnosis requires presence of monoclonal B lymphocytes ≥5 x 109/L in peripheral blood."

Further, for a complete remission (CR): the NCCN guidelines state that "All of the criteria have to be met", namely lymph nodes, liver and spleen size, constitutional symptoms, platelet count, haemoglobin, bone marrow and neutrophils. How are you doing with those?

Neil

[Mrsminton in reply to AussieNeil]

What about immunoglobulin levels - do they ever recover?

[AussieNeil Partner Administrator in reply to Mrsminton]

Some members have reported significant recoveries in their immunoglobulin levels after targeted therapy treatments. I'm not aware of any studies that have looked into why this can sometimes happen.

Neil

[Noelnoel]

How have you achieved remission

[LeoPa]

Because acute infections can push the number somewhat up.

[whitravis]

(You might want to read my last sentence first, tgen back up and sta e r here. CLL is usually diagnosable when the ABSOLUTE lymphocyte count (ALC) is 5000 on up. ALC is lymphocyte % multiplied by total WBC. E.g. if WBC is 8, 000 and % lymphocytes is 80%, then .8 x 8000 = 6,400 which is in CLL range. If I haven't explained this well, Google "how to calculate absolute lymphocyte count" will quicky make it clear. "Lymphocyte count" is ALWAYS expressed as a % indicating the relative quantity of the WBC that are present. The ALC /absolute neutrophil count is a quantity and should NEVER be expressed as a %. This is the simple way to find the distinction and implications of these numbers. This distinction seems to be missed in most or all of the prior conversation here.