Nicole Lamanna, MD, discusses the significance of the watch-and-wait approach early on in a diagnosis of chronic lymphocytic leukemia.
PUBLISHED January 24, 2018
Nicole Lamanna, MD: In the absence of big bulky lymph nodes, or in the scenario where their good counts are low, people are monitored. Now, this is that period that they call watch-and-wait. Many of our patients call it watch-and-worry. It’s tough for our patients. I always tell somebody who is newly diagnosed that the first year of the diagnosis, and knowing you have a blood disorder, blood cancer, or chronic lymphocytic leukemia, is stressful. You have good days and bad days. It takes about a year to a year and a half, in my experience, for them to get what they have and be comfortable with the fact that they’re living with a disease that they’re just not treating right now.
And so, I liken it to other chronic diseases like high blood pressure, diabetes, or heart disease. They’re just actively getting medications for their problems. We’re just not actively treating the leukemia right now. This is for a very good reason. Of course, you get a diagnosis of cancer. The goal is to get it out, make it be gone, and be done. We don’t have cures for CLL yet. Years ago, when we started traditional chemo-immunotherapy drugs, we’d see a lot of side effects in patients. And they didn’t benefit long term. If you don’t need it, don’t ask for it.
If we can benefit you by giving you a free period of not needing some therapy that could give you some potential side effects, and if you’re a part of the quarter of patients that never need to have treatment, so be it. Of course, I wish I could reassure that patient. I wish I could do a blood test and know that the patient would never treatment. I wish they could go on and never come to my clinic again. But until we actually have that and understand the biology better, we can’t do that. So, it’s getting everybody sort of adjusted to the fact that they’re living with a new diagnosis and a new illness that just doesn’t need to be treated yet. That is psychologically very difficult, initially. I think it takes time for everybody to get comfortable with that.
But if they stay in the mindset that there are a lot of other medical problems where active treatments are needed, and that this case is just one where we don’t need treatment, they should benefit from that. In other words, that period of not having anything is really beneficial. Particularly, as we’re getting new drugs that may be better, if they advance the disease or we find a drug that cures all and has little side effects, then that’ll be different. Right? So, as soon as somebody gets diagnosed, if we have everything that will cure everybody for CLL, that would be a different issue. Then everybody gets treated sooner. Until that happens, you need to watch and wait, and be accustomed to learning about your body infections. Other things that I teach my patients about initially are good health care maintenance, screening for other cancers, and calling us if they have developed any signs or symptoms of an infection. Those are the things that I educate my patients about in the beginning, as we are getting more blood work from them to help prognosticate them, to let them know a little bit about their biology, which may be different from someone else with CLL. And then, also how they can look at their life.
And so, I think that first initial period is tough for a patient. But the tempo of their disease is more important. Until we have better treatments, monitoring their disease is very appropriate, initially. And that tells us something about their biology. So, the longer somebody is monitored and doesn’t need treatment, they may be that quarter of patients. I actually see those patients less frequently over the years.