Losing significant weight without trying and feeling continually exhausted may be some of the symptoms of Chronic Lymphocytic Leukemia. (CLL)
CLL is a type of cancer that affects older adults, often white men, and it can be present long before it causes symptoms. It may also be harder to treat than other forms of leukemia.
To learn more about CLL, tune into SMG Radio to hear Dr. David Gallinson, a specialist in cancer, discuss the symptoms and treatment of this form of leukemia.
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Chronic Leukemia
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Learn more about David Gallinson, DO
David Gallinson, DO
David Gallinson, DO, specializes in hematology and oncology at Summit Medical GroupLearn more about David Gallinson, DO
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Chronic Leukemia
Melanie Cole (Host): Losing significant weight without trying and feeling continually exhausted may be some of the symptoms of chronic lymphocytic leukemia. My guest today is Dr. David Gallinson. He specializes in hematology and oncology at Summit Medical Group. Welcome to the show, Dr. Gallinson. What is leukemia?
Dr. David Gallinson (Guest): That is an excellent question and a word that strikes fear in many. When we hear about leukemia, clearly we think that's a disease of the white blood cells but, fortunately for many patients, leukemia isn't as severe a diagnosis as it could be. We divide leukemias into those that are acute and those that are chronic. The acute leukemias are the patients that we need to put in the hospital right away. Chronic leukemias patients are often walking into my office feeling healthy.
Melanie: So, then, what would even send them to your office? What are some symptoms of a type of chronic leukemia?
Dr. Gallinson: Well, the most common leukemia that we see is called “CLL” or lymphocytic leukemia. There are many subtypes and if we focus on that a little bit, truly the majority of my patients are asymptomatic. They've gone for their routine physical to their primary care doctor who identified an elevated white blood cell count and needs further assistance in working it up and then I meet the patient.
Melanie: So, they've gotten their blood test and they've seen that elevated white blood cell. It's a cause for concern. Then, they come to see you. How do you determine what they have? Tell us what CLL is.
Dr. Gallinson: So, CLL, again, is among the chronic leukemias and in your body you have different types of white blood cells. One of those subtypes is lymphocytes and lymphocytes’ usual job is fighting viruses, but sometimes if there's a mutation, it causes an elevation in the lymphocytes. So, if you see a patient that looks not like they have an infection, but have a certain elevation in the lymphocyte count, we think this could be a leukemia. And, this leukemia really travels through different courses and maybe initially asymptomatic and then we have a plan for how we follow patients and decide when they need treatment but often after a period of surveillance.
Melanie: Are there certain risk factors that would predispose someone to a type of leukemia?
Dr. Gallinson: Well, some of the leukemias, and the risk factors are mostly well-described in the acute leukemias, the chronic leukemias, I would say that it's a combination of your environmental exposures, or the genetics that you're born with, but often it’s something that we don't see until patients are around 70 as opposed to hereditary cancers, we usually think of as presenting at a younger age.
Melanie: So, then, what are some factors that will affect the treatment options and prognosis of a chronic leukemia?
Dr. Gallinson: So, what we usually do in these cases, again, it's a chronic leukemia. They're over producing lymphocytes, and these lymphocytes are mature cells and don't cause damage in and of themselves and patients, if their normal white count is 10,000, they could walk into your office with a white count of 100,000 and be feeling perfectly fine. When I meet them, I'm going to ask them questions such as, “Have you lost weight? Have you been having night sweats? Do you have severe fatigue? Are you having high fevers?” And then, I'll focus on where I know lymph nodes are, where your spleen and liver are, and if you have symptoms related to an enlarged lymph node or enlarged liver and enlarged spleen.
Melanie: Then, when we're looking at the treatments, what treatments are out there today for chronic leukemia?
Dr. Gallinson: So, after we've seen this patient and before we get to treatment, it's important to confirm the diagnosis and we do different tests in hematology. Fortunately, the diagnostic tests really can be done all on bloodwork. The bloodwork both confirms the diagnosis--because there are some other similar looking leukemias and lymphomas that can present with this elevated white count. We see almost 20,000 new cases a year of CLL, so we have a lot of data accumulating and there's a lot of science that's supporting our current treatments. So, in this background, we confirm the diagnosis. We determine who's ready for treatment, and we take into account what is your age? Do you have any other medical problems? How quickly is your disease developing? And then we set some goals for you and we can decide among various treatment options.
Melanie: So, what might some of those options? People have heard about chemotherapy before and people are hearing more and more about immunotherapies. So, tell us about some of the treatments that are out there today.
Dr. Gallinson: So, I usually like to categorize the treatments and there's the classic chemotherapy, another class is the so-called targeted or biologic therapies, and a third class, which you mentioned, is the immunotherapy. The immunotherapy is the one that's really the hot topic in the news and, at this point, there's not an FDA-approved drug for immune treatment of CLL. They're developed. They're FDA-approved in melanoma and renal cell and Hodgkin's and other diseases, but not quite for CLL. When you think of immune treatment for CLL, we think of a bone marrow transplant or better described as a stem cell transplant. Simply, I would describe that as the first line of defense against an infection is your immune system. The first line of defense against a cancer is your immune system. If the cancer gets a foothold, a new bone marrow is like a new immune system, but that's a treatment that we really save for special situations, younger patients. What's most exciting is the targeted or biologic therapies in CLL.
Melanie: So, let's talk about those because they're absolutely fascinating and teaching your immune system to recognize and attack leukemia cells. Explain that to the listeners a little.
Dr. Gallinson: Well, actually, when I talk about the targeted therapy and the biologic therapies, it's a little bit different than you're describing. When you talk about teaching the immune system to better engage in the fight against the cancer, we're not doing it actively in CLL right now. So, what's more appropriate is if you talk about the targeted therapies. In cancer, we've always focused on things growing out of control at a rapid rate of growth, which is when we've thought about chemotherapy, which is a class that we've been using for years--killing rapidly dividing cells. But, in CLL, it's more of an accumulation of what would be described as functionally incompetent lymphocytes. Not the ones that we need to fight viruses, but what's happened is there's something called “programmed cell death” or “apoptosis”, so we're focusing on targeted therapies that allow these cells to go through their natural death. It inhibits this overproduction as opposed to the classic, in a simplified description of chemotherapy, killing rapidly dividing cells. This has produced therapies that our patients, again, who are, on average, aged over 70, can receive without dealing with the classic chemotherapy side effects and oftentimes, there's pills that we're asking a patient to take which work through these very sophisticated, well-developed mechanisms, rather than, while chemotherapy is helpful and often used in combination with targeted therapies, in our older, more frail patients, or patients who don't need as an aggressive a therapy can have this option.
Melanie: That's fascinating and is the program cell death being used on a regular basis?
Dr. Gallinson: So, in the past few years, there are at least three drugs that I can think of off the top of my head, FDA-approved in this disease and that do not need to be given with chemotherapy. Four, actually, off the top of my head. For a younger patient who’s maybe having maybe a more aggressive course and has, you know, a better performance that is stronger, chemotherapy is still is the textbook answer and there's, you know, longer-standing data for chemotherapy in the right patient. Because in this disease where I can't cure them, you know, the goal is really to help them live out their natural life by converting a disease into a chronic illness, like diabetes and hypertension. Sometimes, chemotherapy does give you the longest treatment-free intervals. These targeted therapies, though, for a patient who is older, they're FDA-approved and were particularly studied in the over-70 population, to be safe and effective and can control disease and make patients feel better and prolong their survival.
Melanie: What do you tell families, Dr. Gallinson, when somebody is diagnosed with a chronic leukemia or CLL, what do you tell families about coping, support, lifestyles? What do you want them to know about living with this disease?
Dr. Gallinson: Well, what we need to do first, in terms in giving a prognosis, is usually delivering the appropriate perspective. How old is the patient? Do they have a heart condition or lung condition or other competing serious medical problems? Then, I come back and focus on the CLL and sometimes, you only have only one data point. You need to get to know that leukemia, see how it's progressing, where the disease is, what vital organs it's affecting, and then, what we're doing more and more is looking at mutations. There are certain mutations, such as the T53 mutation or chromosome 13 alteration that could predict either a good outcome or a bad outcome. It’s really to help people anticipate what that road is going to be like and also help us choose our treatments. So, once we put in perspective how healthy are they without their CLL, how serious their CLL is, then we can help them prioritize. “This is something that you're going to be dealing with for 10 years.” Or, maybe this is a more aggressive course and we really need to make sure that you have the right support system at home, that you're maybe slowing down at work, maybe you're focusing on really important things like spending good time with your family. We try to help guide patients toward the right perspective on coping with an illness that presents with various levels of severity.
Melanie: Tell us about your team at Summit Medical Group.
Dr. Gallinson: So, we are a group of 600 doctors and we recently expanded our oncology service line. Now, we're up to 14 oncologists, nurse practitioners. It's really comprehensive care that we give here from the doctors, the nurses, the social workers, the dietitians. We feel like we've really put together a good group of doctors, pathologists and radiologists. We all work together and I really feel that we do deliver really excellent care for our patients. And, if you're in a position where you have a white count and there is a concern, we're here to help.
Melanie: Thank you so much for being with us today. What a great topic. You're listening to SMG Radio and for more information, you can go to wwwsummitmedicalgroup.com. That's summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.
Chronic Leukemia
Melanie Cole (Host): Losing significant weight without trying and feeling continually exhausted may be some of the symptoms of chronic lymphocytic leukemia. My guest today is Dr. David Gallinson. He specializes in hematology and oncology at Summit Medical Group. Welcome to the show, Dr. Gallinson. What is leukemia?
Dr. David Gallinson (Guest): That is an excellent question and a word that strikes fear in many. When we hear about leukemia, clearly we think that's a disease of the white blood cells but, fortunately for many patients, leukemia isn't as severe a diagnosis as it could be. We divide leukemias into those that are acute and those that are chronic. The acute leukemias are the patients that we need to put in the hospital right away. Chronic leukemias patients are often walking into my office feeling healthy.
Melanie: So, then, what would even send them to your office? What are some symptoms of a type of chronic leukemia?
Dr. Gallinson: Well, the most common leukemia that we see is called “CLL” or lymphocytic leukemia. There are many subtypes and if we focus on that a little bit, truly the majority of my patients are asymptomatic. They've gone for their routine physical to their primary care doctor who identified an elevated white blood cell count and needs further assistance in working it up and then I meet the patient.
Melanie: So, they've gotten their blood test and they've seen that elevated white blood cell. It's a cause for concern. Then, they come to see you. How do you determine what they have? Tell us what CLL is.
Dr. Gallinson: So, CLL, again, is among the chronic leukemias and in your body you have different types of white blood cells. One of those subtypes is lymphocytes and lymphocytes’ usual job is fighting viruses, but sometimes if there's a mutation, it causes an elevation in the lymphocytes. So, if you see a patient that looks not like they have an infection, but have a certain elevation in the lymphocyte count, we think this could be a leukemia. And, this leukemia really travels through different courses and maybe initially asymptomatic and then we have a plan for how we follow patients and decide when they need treatment but often after a period of surveillance.
Melanie: Are there certain risk factors that would predispose someone to a type of leukemia?
Dr. Gallinson: Well, some of the leukemias, and the risk factors are mostly well-described in the acute leukemias, the chronic leukemias, I would say that it's a combination of your environmental exposures, or the genetics that you're born with, but often it’s something that we don't see until patients are around 70 as opposed to hereditary cancers, we usually think of as presenting at a younger age.
Melanie: So, then, what are some factors that will affect the treatment options and prognosis of a chronic leukemia?
Dr. Gallinson: So, what we usually do in these cases, again, it's a chronic leukemia. They're over producing lymphocytes, and these lymphocytes are mature cells and don't cause damage in and of themselves and patients, if their normal white count is 10,000, they could walk into your office with a white count of 100,000 and be feeling perfectly fine. When I meet them, I'm going to ask them questions such as, “Have you lost weight? Have you been having night sweats? Do you have severe fatigue? Are you having high fevers?” And then, I'll focus on where I know lymph nodes are, where your spleen and liver are, and if you have symptoms related to an enlarged lymph node or enlarged liver and enlarged spleen.
Melanie: Then, when we're looking at the treatments, what treatments are out there today for chronic leukemia?
Dr. Gallinson: So, after we've seen this patient and before we get to treatment, it's important to confirm the diagnosis and we do different tests in hematology. Fortunately, the diagnostic tests really can be done all on bloodwork. The bloodwork both confirms the diagnosis--because there are some other similar looking leukemias and lymphomas that can present with this elevated white count. We see almost 20,000 new cases a year of CLL, so we have a lot of data accumulating and there's a lot of science that's supporting our current treatments. So, in this background, we confirm the diagnosis. We determine who's ready for treatment, and we take into account what is your age? Do you have any other medical problems? How quickly is your disease developing? And then we set some goals for you and we can decide among various treatment options.
Melanie: So, what might some of those options? People have heard about chemotherapy before and people are hearing more and more about immunotherapies. So, tell us about some of the treatments that are out there today.
Dr. Gallinson: So, I usually like to categorize the treatments and there's the classic chemotherapy, another class is the so-called targeted or biologic therapies, and a third class, which you mentioned, is the immunotherapy. The immunotherapy is the one that's really the hot topic in the news and, at this point, there's not an FDA-approved drug for immune treatment of CLL. They're developed. They're FDA-approved in melanoma and renal cell and Hodgkin's and other diseases, but not quite for CLL. When you think of immune treatment for CLL, we think of a bone marrow transplant or better described as a stem cell transplant. Simply, I would describe that as the first line of defense against an infection is your immune system. The first line of defense against a cancer is your immune system. If the cancer gets a foothold, a new bone marrow is like a new immune system, but that's a treatment that we really save for special situations, younger patients. What's most exciting is the targeted or biologic therapies in CLL.
Melanie: So, let's talk about those because they're absolutely fascinating and teaching your immune system to recognize and attack leukemia cells. Explain that to the listeners a little.
Dr. Gallinson: Well, actually, when I talk about the targeted therapy and the biologic therapies, it's a little bit different than you're describing. When you talk about teaching the immune system to better engage in the fight against the cancer, we're not doing it actively in CLL right now. So, what's more appropriate is if you talk about the targeted therapies. In cancer, we've always focused on things growing out of control at a rapid rate of growth, which is when we've thought about chemotherapy, which is a class that we've been using for years--killing rapidly dividing cells. But, in CLL, it's more of an accumulation of what would be described as functionally incompetent lymphocytes. Not the ones that we need to fight viruses, but what's happened is there's something called “programmed cell death” or “apoptosis”, so we're focusing on targeted therapies that allow these cells to go through their natural death. It inhibits this overproduction as opposed to the classic, in a simplified description of chemotherapy, killing rapidly dividing cells. This has produced therapies that our patients, again, who are, on average, aged over 70, can receive without dealing with the classic chemotherapy side effects and oftentimes, there's pills that we're asking a patient to take which work through these very sophisticated, well-developed mechanisms, rather than, while chemotherapy is helpful and often used in combination with targeted therapies, in our older, more frail patients, or patients who don't need as an aggressive a therapy can have this option.
Melanie: That's fascinating and is the program cell death being used on a regular basis?
Dr. Gallinson: So, in the past few years, there are at least three drugs that I can think of off the top of my head, FDA-approved in this disease and that do not need to be given with chemotherapy. Four, actually, off the top of my head. For a younger patient who’s maybe having maybe a more aggressive course and has, you know, a better performance that is stronger, chemotherapy is still is the textbook answer and there's, you know, longer-standing data for chemotherapy in the right patient. Because in this disease where I can't cure them, you know, the goal is really to help them live out their natural life by converting a disease into a chronic illness, like diabetes and hypertension. Sometimes, chemotherapy does give you the longest treatment-free intervals. These targeted therapies, though, for a patient who is older, they're FDA-approved and were particularly studied in the over-70 population, to be safe and effective and can control disease and make patients feel better and prolong their survival.
Melanie: What do you tell families, Dr. Gallinson, when somebody is diagnosed with a chronic leukemia or CLL, what do you tell families about coping, support, lifestyles? What do you want them to know about living with this disease?
Dr. Gallinson: Well, what we need to do first, in terms in giving a prognosis, is usually delivering the appropriate perspective. How old is the patient? Do they have a heart condition or lung condition or other competing serious medical problems? Then, I come back and focus on the CLL and sometimes, you only have only one data point. You need to get to know that leukemia, see how it's progressing, where the disease is, what vital organs it's affecting, and then, what we're doing more and more is looking at mutations. There are certain mutations, such as the T53 mutation or chromosome 13 alteration that could predict either a good outcome or a bad outcome. It’s really to help people anticipate what that road is going to be like and also help us choose our treatments. So, once we put in perspective how healthy are they without their CLL, how serious their CLL is, then we can help them prioritize. “This is something that you're going to be dealing with for 10 years.” Or, maybe this is a more aggressive course and we really need to make sure that you have the right support system at home, that you're maybe slowing down at work, maybe you're focusing on really important things like spending good time with your family. We try to help guide patients toward the right perspective on coping with an illness that presents with various levels of severity.
Melanie: Tell us about your team at Summit Medical Group.
Dr. Gallinson: So, we are a group of 600 doctors and we recently expanded our oncology service line. Now, we're up to 14 oncologists, nurse practitioners. It's really comprehensive care that we give here from the doctors, the nurses, the social workers, the dietitians. We feel like we've really put together a good group of doctors, pathologists and radiologists. We all work together and I really feel that we do deliver really excellent care for our patients. And, if you're in a position where you have a white count and there is a concern, we're here to help.
Melanie: Thank you so much for being with us today. What a great topic. You're listening to SMG Radio and for more information, you can go to wwwsummitmedicalgroup.com. That's summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.