NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

9 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2019 1  CLL basics Tests for CLL Tests for CLL Often, CLL is suspected after routine blood work. Your white blood cell counts may be high. More blood tests are needed to confirm (diagnose) CLL. Some people will need a biopsy of lymph nodes if blood tests don’t work. Blood and tissue samples will be sent to a doctor called a hematopathologist. These doctors spend all their time looking at blood, bone marrow, and lymph nodes. They become very good at diagnosing blood cancers. Flow cytometry is a newer lab test. It can be used to count B cells and test for proteins. IHC ( i mmuno h isto c hemistry) is an older method that can also be used. B-cell count The number of abnormal B cells in your blood will be counted. Diagnosis of CLL requires at least 5,000 abnormal B cells per microliter of blood (5 x 10 9 /L). The B cells have to be copies of the same “parent” cell. This is called monoclonality. Figure 2 Genetic material in cells Most human cells contain a plan called the “blueprint of life.” It is a plan for how our bodies are made and work. It is found inside of chromosomes. Chromosomes are long strands of DNA that are tightly wrapped around proteins. Genes are small pieces of DNA. Humans have about 20,000 to 25,000 genes. Snapshot: Monoclonal B-lymphocytosis If you don’t have CLL, you may have MBL ( m onoclonal B l ymphocytosis). MBL is common, especially among older adults. It is not cancer and very few people with MBL develop CLL. The first step of care is to watch and wait (also called observation). Observation is a period of testing to assess for changes in status. Some people won’t need treatment for years if at all.