• Posted April 9, 2024

Can Older Patients With Low-Risk Leukemia Quit Seeing Specialists?

Some slow-growing cases of leukemia don't need constant surveillance by cancer specialists, a new study claims.

Low-risk patients with slow-growing chronic lymphocytic leukemia (CLL) and no symptoms fared well even after they stopped seeing doctors for specialized blood tests, researchers report.

The patients had fewer hospital visits, fewer infections and similar survival after three years compared to CLL patients who kept going to the doctor.

“To the best of our knowledge, ours is the first study of what happens when specialist follow-up for CLL is stopped,” said senior researcher Dr. Carsten Niemann, chief physician of hematology at Rigshospitalet in Copenhagen, Denmark.

“Our findings show that it's feasible to discontinue specialized 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,” Niemann said.

About 84% of the patients showed no signs that their leukemia had progressed after three years, Niemann noted.

CLL is the most common blood cancer in adults, but the leukemia can behave very differently in each patient. For some, it grows aggressively, but for others it grows very slowly.

The average age of diagnosis for CLL is 70, and so-called "indolent" CLL can remain stable for years without treatment.

Prior studies have indicated that up to 3 in 10 CLL patients never need treatment, but these patients often receive years of specialized follow-up anyway, researchers said. Such “watchful waiting” -- repeating a battery of exams and blood tests -- can cause patients unnecessary worry and distress.

In 2022, Niemann and his colleagues created a validated list of symptoms that identified more than 40% of patients with CLL whose annual risk of needing treatment was less than 2 in 100.

The new study tested that symptom list by ending specialist follow-up for very low-risk patients.

For the study, researchers selected 112 patients whose leukemia symptoms indicated they had slow-growing CLL and a low risk of eventually needing treatment.

The patients were told they didn't need to bother with follow-up for three years, but that they should get vaccinated against pneumonia and influenza. They also were told to contact their primary care doctor if they developed a fever, chills, night sweats, weight loss or symptoms of infection.

Meanwhile, another 88 patients with low-risk CLL continued their periodic check-up visits with blood specialists.

In the group that discontinued care, 14 patients wound up dying during the three-year study period, fewer than the 19 deaths that occurred in patients who continued specialized care, results showed.

Causes of death included infections, other cancers, heart disease, stroke, trauma and Alzheimer's disease, researchers said.

Among all the patients, there were a total of 2,811 hospital visits. Patients who ended follow-up care represented just 31% of those visits, while the group that continued care represented the rest.

About 45% of patients who discontinued follow-up care needed antibiotics to treat infections, compared with 51% of those who kept seeing a specialist.

The new study was published recently in the journal Blood Advances.

“We have demonstrated that more than half of patients with low to intermediate risk for ever needing CLL treatment may safely be selected to stop specialized follow-up,” lead researcher Dr. Christian Brieghel, a postdoctoral fellow in hematology at Rigshospitalet, said in a journal news release.

“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 specialized follow-up care,” Brieghel added.

More information

The American Cancer Society has more about chronic lymphocytic leukemia.

SOURCE: Blood Advances, news release, April 4, 2024