11 April 2024

Patients with low-risk chronic lymphocytic leukaemia (CLL) may not need specialist follow-up, according to a new study in Denmark.

Doctors in Copenhagen had previously developed a list of symptoms that indicate low risk patients, who have an annual risk of needing treatment of 2% or less. These represent 40% of CLL patients they say.

However, the researchers say that specialist follow up, even when described as “watchful waiting”, involves blood tests and physical exams, and may cause patients significant psychological distress.

For the latest study, reported in Blood Advances, the doctors discharged 112 low risk patients from specialist follow up and monitored them for three years. Another 88 patients continued with specialist follow up appointments.

The patients were advised to ensure they were vaccinated against pneumonia and flu and to contact a general practitioner if they developed key symptoms such as weight loss.

The researchers report that 16% of these patients developed signs of disease progression, and that they received “timely” treatment. 14 patients in this group died compared with 19 of the 88 patients who continued to receive follow up care.

45% of these patients developed infections that were treated with antibiotics compared with 51% of those receiving continuous follow up care.

One limitation of the study is that it was not randomised, in that the researchers selected patients who met specific low-risk criteria to discontinue their follow-up.

Study leader Dr Carsten Niemann, chief physician in the department of haematology at Rigshospitalet in Copenhagen, Denmark, and associate professor at the University of Copenhagen, said: “Our findings show that it’s feasible to discontinue specialised follow-up in patients who have a very low risk of needing CLL treatment and that doing so does not cause these patients any harm.”

First author of the study Dr Christian Brieghel said: “They had lower use of hospital and health care resources, a lower frequency of infections, and if they had an infection, they were hospitalized for a shorter time - and their overall survival was comparable to similar patients who continued specialised follow-up care.”


Brieghel C, da Cunha-Bang C, Mourek J, Kjeldsen L, Niemann CU. (2024) “It is feasible and safe to stop specialized follow-up of asymptomatic lower risk chronic lymphocytic leukemia.” Blood Advances, 1 March 2024, doi: 10.1182/bloodadvances.2023012382

Link: https://ashpublications.org/bloodadvances/article/doi/10.1182/bloodadvances.2023012382/515174/It-is-feasible-and-safe-to-stop-specialized-follow

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