Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are complex diseases that require careful monitoring. Despite their serious nature, many patients are advised to adopt a ‘watch and wait’ approach rather than immediate treatment. In this article, we explore the reasons behind this strategy, how long the ‘watch and wait’ period typically lasts, and what symptoms and lifestyle considerations patients should be aware of during this time. We also cover potential treatment options and ways to improve outcomes.
Why Do We ‘Watch and Wait’?
Understanding CLL and SLL
CLL and SLL are similar diseases: CLL affects the blood, while SLL impacts the lymph nodes. Both conditions can present varied outcomes, heavily influenced by the aggressiveness of the disease. For many patients, these diseases progress slowly, allowing them to maintain a typical life span without significant symptoms. In such cases, the side effects of treatment may outweigh the benefits, making the ‘watch and wait’ approach a sensible option.
Benefits of the ‘Watch and Wait’ Approach
- Avoiding Unnecessary Side Effects: Many treatments for CLL and SLL come with side effects that can diminish quality of life. By delaying treatment until it’s absolutely necessary, patients can avoid these negative impacts.
- Monitoring Disease Progression: Regular monitoring allows doctors to assess the disease’s progression and determine the optimal time to start treatment if needed.
How Long Does the ‘Watch and Wait’ Period Usually Last?
The duration of the ‘watch and wait’ period varies from patient to patient. Initially, patients undergo lab work and physical exams every three months. If there are no signs of aggressive disease activity after the first year, the frequency of follow-ups may be reduced. Treatment begins if symptoms develop, such as uncomfortable swelling of lymph nodes or spleen, anemia, or thrombocytopenia (low blood counts).
Symptoms to Look Out For
During the ‘watch and wait’ period, it’s crucial for patients to monitor their health and report any concerning symptoms to their doctor. Key symptoms include:
- Significant fatigue
- Night sweats occurring once a month
- Unexplained fevers lasting two weeks
- Unintentional weight loss of more than 10% of body weight
What to Do If Symptoms Occur
If any of these symptoms arise, it’s important to contact your doctor for further testing. While it’s not always necessary to contact your doctor at the first sign of these symptoms, persistent issues should not be ignored. Additionally, patients should avoid close physical contact with anyone who’s sick to reduce the risk of infections.
Lifestyle Considerations During the ‘Watch and Wait’ Period
Generally, the ‘watch and wait’ period doesn’t impose significant lifestyle limitations. However, patients should take certain precautions and adopt healthy habits:
- Avoid Close Contact with Sick Individuals: This helps reduce the risk of infections.
- Maintain a Healthy Lifestyle: Regular exercise and a balanced diet can improve overall health. Discuss standard vaccinations with your doctor.
Treatment Options When Needed
When the disease becomes active, several treatment options are available:
- Chemoimmunotherapy: This combination of chemotherapy and immunotherapy can be administered via pills or intravenous (IV) medications. Common pills include BTK inhibitors (ibrutinib, acalabrutinib, zanubrutinib) and BCL2 inhibitors (venetoclax). IV medications often include obinutuzumab or rituximab.
- Traditional Chemotherapy: Although less common, traditional chemotherapy may be used based on specific factors like the likelihood of the cancer responding to treatment and the patient’s age.
Increasing Chances of Positive Outcomes
To improve the chances of a positive outcome, patients should adhere to the recommended schedule of lab testing and oncologist checkups, especially in the first year after diagnosis. Maintaining a healthy lifestyle, reducing processed and sugar-based foods, and regular exercise can also positively impact overall health.
Support for Patients and Caregivers
A diagnosis of CLL or SLL doesn’t have to be life-changing, especially during the ‘watch and wait’ period. It’s important for patients to avoid identifying solely with their disease, as stress can lead to depression and other health issues. Caregivers play a crucial role in providing emotional support, discussing concerns, and assisting with managing the disease.
By understanding the rationale behind the ‘watch and wait’ approach and knowing what to monitor, patients and caregivers can navigate this period with confidence and preparedness. Regular communication with healthcare providers and maintaining a healthy lifestyle are key components to successfully managing CLL and SLL.
