NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

21 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 2 Treatment planning Bone and marrow test The contrast may cause you to feel flushed or get hives. Rarely, serious allergic reactions occur. Tell your doctor and the technicians if you have had bad reactions to contrast. Also, tell them if you get nervous when in small spaces. You may be given a sedative to help you relax. CT is needed if you have symptoms suggesting your lymph nodes are large. If needed, a CT of your chest, belly area, and between your hip bones is advised. CT scans received during treatment can help your doctors know if treatment is working. PET/CT scan CT is sometimes done along with another imaging test called PET ( p ositron e mission t omography). For PET, a sugar radiotracer will be injected into your body. The radiotracer is detected with a special camera. Cancer cells appear brighter than normal cells because they use sugar (glucose) more quickly. PET/CT is often not useful for CLL. If given, it is used to help direct a needle into a lymph node for a biopsy. Your lymph nodes may be tested if your doctor thinks that CLL is turning into a fast-growing cancer like diffuse large B-cell lymphoma. PET/CT is an essential test for this cancer. Bone and marrow test A bone marrow biopsy removes a sample of bone and soft bone marrow. A bone marrow aspiration removes a small amount of liquid bone marrow. These tests aren’t needed to diagnose CLL. However, your doctor may order these tests to learn what’s causing low numbers of blood cells. Often, these tests are done at the same time on the back of hip bone. You may receive a light sedative before the test. You will likely lie on your side as shown in Figure 8. Your doctor will clean your skin then give local anesthesia to numb the site. Once numb, a hollow needle will be inserted into your skin and then pushed into the bone to remove the liquid bone marrow with a syringe. Then, a wider needle will be inserted into the bone and rotated to remove bone and soft marrow. These biopsies may cause bone pain and can bruise your skin for a few days. The samples will be sent to a lab for testing. Figure 8 Bone marrow biopsy Doctors use a bone marrow biopsy to remove a sample of bone and marrow for testing. A bone marrow aspiration removes a small amount of liquid bone marrow. Illustration Copyright © 2017 Nucleus Medical Media, All rights reserved.