Nodules and Chronic Lymphocytic Leukemia

[TeachMath]

My Dad was diagnosed with CLL (Chronic Lymphocytic Leukemia) about two years ago. His cancer has been passive. He recently went for a stomach and chest CT scan. The scans revealed a nodule on his lung and a nodule on one of his thyroids. I need to know whether these nodules are in direct link with the cancer and what they are, will they go away in time, are they harmful? Is this something CLL patients normally encounter?

[Fernando Roque, MD]

Hi.  Procrit (erythropoetin alpha) is given to cancer patients during chemotherapy to avoid the need for blood transfusions.  During chemotherapy, the hemoglobin is maintained at a level of 10 to less than 12 grams/deciliter.  Increasing hemoglobin levels to more than 12 g/dl is detrimental to the patient's well-being, and erythropoeitin doses are typically reduced when the hemoglobin level begins to approach 12.  But the reason your father is not being given a 60 mg Procrit dose may be because he's not receiving any chemotherapy at present. Procrit is indicated for treating chemotherapy-induced anemia, and not for anemia in cancer patients which is due to other things like iron or folate deficiency, or chronic blood loss from tumor bleed or gastrointestinal bleeding.  In these cases, he can increase his red cell levels further by proper nutrition, and iron supplements, instead of resorting to the use of Procrit.

[Olivia8222]

Hi, My father is being given Procrit 40mg almost weekly if not weekly yet his numbers are at 10.2, 10.7.  My mother tells me that he feels his best for 79 yrs old when his number is at 12.  The doctor will not give him the 60mg like he used to.  We are desperate for help.  What I keep being told is that Medicare frowns on them giving my father 60mg.
Help, please, help!!!

[Fernando Roque, MD]

Hi. Chronic Lymphocytic Leukemia doesn't usually manifest as thyroid nodules.  However, leukemic infiltrates and enlarged lymph nodes in the lungs can be found in this disease.  The only way to know for certain if those nodules represent aggregates of leukemic cells is to do a biopsy.  Alternatively, if your father feels well and doesn't manifest with any symptoms, he can choose to just observe those nodules over time and have a repeat CT scan after 4-6 months to see if there are any changes.    If those nodules are shown to be progressively enlarging on repeat scan, then treatment may be warranted.