Chronic lymphocytic leukaemia in older adults

Being older does not by itself determine whether treatment is needed or which treatment is suitable. Some people are monitored for a long period without treatment, while others need therapy because the disease is causing symptoms or affecting healthy blood cells.

CLL begins in a type of white blood cell called a B lymphocyte. Abnormal cells can accumulate in the blood, bone marrow, lymph nodes and spleen. This may lead to enlarged lymph nodes, tiredness, repeated infections, easy bruising, weight loss or night sweats, although a routine blood test may find CLL before any symptoms appear.

The care team looks at the pattern over time rather than one result alone. They may assess blood counts, examine lymph nodes and the spleen, review symptoms and use tests that describe the leukaemia cells. Heart, kidney and lung health, other medicines, mobility and what matters most to you help shape a treatment choice.

Keep scheduled blood tests and clinic visits even when you feel well. Record new infections, drenching night sweats, unexplained weight change, increasing fatigue, bruising and rapidly enlarging glands so the team can judge whether the condition is changing. Bring an up-to-date list of prescriptions, non-prescription medicines and supplements to each review.

If monitoring is recommended, this is active surveillance rather than neglect. Treatment is generally considered when CLL causes significant symptoms, progressive enlargement of lymph nodes or spleen, or worsening blood counts. Before starting therapy, ask how the proposed option fits with your other conditions and whether any medicines need adjustment.

Contact your cancer team promptly for fever, chills, a new cough, burning when passing urine or another possible infection, because CLL and some treatments can reduce infection defences. Also report unusual bleeding, many new bruises, marked breathlessness, rapidly worsening weakness, drenching night sweats or glands that enlarge quickly.

Seek urgent medical help for severe difficulty breathing, chest pain, confusion, fainting, bleeding that will not stop or signs of a severe allergic reaction after medicine. Tell the emergency team that you have CLL and name any cancer treatment you are taking.

Ask what your blood-count trend shows, what changes would trigger treatment, how often monitoring is planned and whom to call with a possible infection. It can also help to discuss how each treatment option may interact with heart or kidney problems, blood thinners and other regular medicines, and whether support is available for fatigue or daily activities.