Asymptomatic patient with lymphocytosis has little chance of dying soon | News, Sports, Employment

DEAR DR. ROACH: I am 71 years old. In 2021, I was diagnosed with lymphocytosis during preoperative workup for breast cancer. I underwent a successful lumpectomy and radiation therapy, and I have been taking anastrozole for five years.

After reviewing my previous CBCs, lymphocytosis was detected dating back to 2018. This was thought to be due to an infection, so no other tests were done at the time. I have now had flow cytometry done, with findings of the IGHV mutation. I received a “favorable prognosis.” But my oncologist did not give me a definitive diagnosis of chronic lymphocytic leukemia (CLL). As he states, “I have not converted” and I have no symptoms of fatigue, enlarged spleen, or enlarged lymph nodes.

I am waiting for the worst to pass and am finding it difficult to enjoy the breast cancer survival for which I am so grateful. I would greatly appreciate any information you can provide on whether chronic lymphocytic leukemia is inevitable in patients with lymphocytosis. Also, I would appreciate your comment on the expected quality and length of life if chronic lymphocytic leukemia is diagnosed, including the need for chemotherapy. — EB

ANSWER: “Lymphocytosis” is a condition in which the body’s lymphocyte count is increased. There are two major categories of white blood cells: lymphocytes and granulocytes. When the lymphocyte count exceeds 4,000, it is considered “lymphocytosis.”

There are two main classes of lymphocytes: B cells and T cells. While it’s true that a high lymphocyte count can be due to infections, it sounds like yours wasn’t recognized as persistent. If lymphocytosis has been present for five years, there is concern that it may be a primary bone marrow disease, the most common of which is CLL. In CLL, by definition, there is a count of 5,000 or more B cells. Since you have lymphocytosis but not CLL, you must have at least 4,000 lymphocytes but fewer than 5,000 B cells.

The word “leukemia” literally means too many white blood cells in the blood, but leukemias are a large and diverse group of blood cancers. It’s a scary word, but chronic lymphocytic leukemia is highly variable. Fifty percent of people with chronic lymphocytic leukemia will live more than 10 years from the time of diagnosis, and some will live 30 years or more before dying, often from something unrelated to leukemia.

The outlook for chronic lymphocytic leukemia depends on many factors. Most cases of chronic lymphocytic leukemia found today are due to routine blood tests that show an elevated white blood cell count. When a person has no symptoms and, like you, does not have an enlarged spleen or lymph nodes, he or she is in a favorable prognosis group. If a person has symptoms, the outlook is not as good. The leukemia cells “crowd out” other healthy cells in the bone marrow, causing anemia and thrombocytopenia, which also have less favorable prognoses.

People who have genetic mutations in the IGHV region receive a surprisingly better prognosis compared to people who do not have mutations. These genetic mutations are always sought, as they affect the choice of chemotherapy, if necessary.

In your case, you have had lymphocytosis for at least five years and it has not progressed to CLL. You have no risk factors for symptoms and you have not told me that you have low platelets or red blood cells. Even if you were diagnosed with CLL today, you would have a greater than 90% chance of living at least 10 years. You appear to be in the 30% of people with CLL who have a benign course for 10 to 20 years. Please drive carefully, eat well, and get all your vaccinations, as you are not likely to die from CLL.