What are the common complications of CLL that I should be aware of during routine follow-up?

Chronic lymphocytic leukaemia (CLL) is a type of low-grade non-Hodgkin's lymphoma, and during routine follow-up, it is important to be aware of several common complications. These include the risk of transformation to a more aggressive high-grade lymphoma, which can significantly alter prognosis and management. Patients may also experience immunosuppression leading to increased susceptibility to infections. Additionally, complications related to bone marrow failure such as anaemia, thrombocytopenia, and neutropenia can occur. Autoimmune phenomena, including autoimmune haemolytic anaemia and immune thrombocytopenia, are also recognized complications. Furthermore, patients may develop secondary malignancies and experience late effects related to their lymphoma subtype or its treatment. It is essential to provide patients with information on how to recognise possible relapse and late effects, and to ensure they have access to specialist support and urgent appointments if new symptoms arise. Regular clinical assessment during follow-up is recommended, with a focus on symptom review rather than routine imaging or laboratory surveillance for relapse in asymptomatic patients. Coordination with specialist teams and provision of end-of-treatment summaries to both patients and their GPs are also important aspects of care.

Key points to monitor during routine follow-up:

• Transformation to high-grade lymphoma
• Infections due to immunosuppression
• Bone marrow failure (anaemia, thrombocytopenia, neutropenia)
• Autoimmune complications (e.g., autoimmune haemolytic anaemia)
• Secondary malignancies
• Late effects of lymphoma and its treatment
• Patient education on relapse symptoms and late effects
• Access to specialist care and urgent appointments

This approach aligns with NICE guidance on non-Hodgkin's lymphoma management and survivorship care.