NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

14 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2019 2  Treatment planning Medical history Your doctors want to learn all about the leukemia you have. This chapter describes who should receive which tests before cancer treatment. It also describes other types of care needed before treatment. Doctors plan treatment using many sources of information. These sources include the health care listed in Guide 1 . Another source is you. Tell your doctor your concerns and goals for treatment. Together, you can share in the decision-making process. Read Part 4 to learn more about making treatment decisions. Medical history Your doctor will ask about any health problems and their treatment during your lifetime. Be prepared to tell what illnesses and injuries you have had. You will also be asked about health conditions and symptoms. It may help to bring a list of old and new medicines to your doctor’s office. Your doctor will ask about symptoms that may be related to CLL. Such symptoms include enlarged lymph nodes, tiredness, a feeling of fullness in your belly, and getting sick. CLL may also cause “B symptoms.” It’s important that your doctor knows if you have them. These symptoms include fevers, chills, night sweats, and weight loss without dieting. Some cancers and other health conditions can run in families. Thus, your doctor will ask about the medical history of your close blood relatives. Such family includes your siblings, parents, and grandparents. Be prepared to tell who has had what diseases and at what ages. Guide 1. Health care before cancer treatment Must haves • Medical history • Physical exam with performance status • CBC with differential • Comprehensive metabolic panel • FISH for chromosomes 11, 12, 13, and 17 • Karyotype • DNA sequencing for IGHV and TP53 mutations Sometimes useful • Beta-2 microglobulin • Haptoglobin, reticulocytes, DAT • LDH • Quantitative immunoglobulins • Uric acid • Bone marrow biopsy and aspiration • Diagnostic CT with contrast • PET/CT • Hepatitis B tests • Echocardiogram or MUGA • Fertility support • Pregnancy test if you can have babies