Episode 422: An Overview of Chronic Lymphocytic Leukemia for Oncology Nurses

“What I appreciate about our patients with chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia is the consideration that they receive a cancer diagnosis, and the best thing for them to do is actually nothing. There is a large population of patients that we don’t recommend any type of treatment. We recommend that they establish care with an oncologist and that they have a relationship with those care teams,” ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP^®, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS^®, TCTCN^™, oncology clinical specialist at ONS, during a conversation about an overview of CLL for oncology nurses.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by July 3, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report increased knowledge of the diagnosis and management of chronic lymphocytic leukemia.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ episodes:
  • Episode 339: A Lesson on Labs: How to Monitor and Educate Patients With Cancer
  • Episode 256: Cancer Symptom Management Basics: Hematologic Complications
• ONS Voice articles:
  • Compensation Funds Curb Financial Burden for Certain Exposure-Related Cancers
  • Infection Prevention for Oncology Nurses
  • Nurse-Led Bone Marrow Biopsy Clinics Truncate Time for Testing, Treatment
  • Patient Stress Linked to More Advanced Leukemia
  • Patients With CLL Report Worse QoL and Other Factors
• Clinical Journal of Oncology Nursing articles: 
  • Care Coordination: Overcoming Barriers to Improve Outcomes for Patients With Hematologic Malignancies in Rural Settings
  • Pseudohyperkalemia in Chronic Lymphocytic Leukemia: An Often Overlooked Clinical Entity
  • Richter Transformation Arising From Chronic Lymphocytic Leukemia
• ONS book: Site-Specific Cancer Series: Leukemia (first edition)
• Hematology, Cellular Therapy and Stem Cell Transplantation Learning Library
• ONS Biomarker Database
• ONS clinical practice resource: Genomics Taxonomy
• Blood Cancer United: Chronic Lymphocytic Leukemia: In Detail
• CLL Society: Patient Education Toolkit
• Lymphoma Research Foundation: Lymphoma and CLL Publications
• National Comprehensive Cancer Network

To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

“Some of the common risk factors are environmental exposures, occupational exposures, and chemical exposures. For example, in certain farming communities where there are pesticides, that can definitely contribute to the risk of developing CLL. There’s some consideration for high levels of radon exposure or exposure to Agent Orange. So our veterans, both from the Vietnam War but also more recently in Iraq. There’s definitely a consideration that those types of exposures increase the risk of developing CLL.” TS 3:01

“Generally, the average age of diagnosis for CLL is in the seventh decade of life. But over 90% of people are diagnosed at age 50 and above. So, this tends to be a diagnosis in the six or seventh decade of life. It’s extremely rare in children, although it has been observed, and it’s twice as likely to develop in men than it is compared to women. And then individuals who are White are more frequently affected by CLL than other racial or ethnic groups, followed by people of color. And that includes Black, Hispanic, and Native American individuals, but it’s rarer in Asian populations.” TS 9:33 

“There’s a lot of adjustment and coping with a new diagnosis. When we think about the diagnostic approach, we get a lot of information that’s incredibly valuable and helps us really to pivot and guide patients as to where they need to go and how we can best support them. We’ve had well-established studies that look to say, ‘If we were to treat patients earlier or have different thresholds for consideration for treatment, do patients do better?’ ... I think it’s really great that we can actually guide patients in a much more precise way, that you don’t need any type of therapy at this point, and it may change and evolve in the future.” TS 20:29

“I have some patients that are doers and they want to do something, so this active surveillance or watch and wait really paralyzes their coping. And so they want to do something. Oftentimes, that’s really when I pull in some integrative strategies and say exercise is always going to be beneficial. The more active you are, the more physically fit you are. If you really want to do something, make sure that you stay hydrated, that you eat well, and you’re engaged in a physical activity that you enjoy and can be consistent with.” TS 32:37

“I think another piece that we don’t often discuss is around the immunoglobulins and the immune system, but CLL has a pretty significant impact on immune dysfunction. And so patients with CLL, even if they are not on any type of active treatment, their immune system doesn’t necessarily function fully. And so they’re more likely to develop some upper respiratory infections or more easily develop the flu or coronavirus. ... Often times, we think a lot about supporting patients to get vaccines and to have early evaluation if those symptoms develop because you’re more likely to develop upper respiratory infections. I think there’s a component around immune dysfunction that I think is really valuable for people to understand that it’s not contingent upon the treatment. It’s contingent upon the disease and mechanistically, how the B cells are dysfunctional and don’t provide that immunity that otherwise would be in a healthy B cell.” TS 42:54