title: Primary care management of early stage chronic lymphocytic leukaemia is safe and effective.
abstract: BACKGROUND
  Chronic lymphocytic leukaemia (CLL) is the commonest leukaemia in western society. Most patients are detected incidentally at an early stage and require 'watch and wait' follow-up. In the UK, management of Stage A0 CLL varies with some centres advising regular outpatient haematology follow-up, whereas others recommend management within primary care. The safety and effectiveness of these two management options are currently unknown.
  
  
  METHODS
  An observational retrospective cohort study in outpatient Haematology clinics at Queen Elizabeth Hospital Birmingham (QEH) and Birmingham Heartlands Hospital (BHH) and primary care practices in West Midlands, UK. All patients diagnosed with stable stage A0 CLL since 2002 at BHH or QEH were identified. At BHH, patients were discharged to primary care follow-up, whilst QEH patients remained under haematology for follow-up. Evidence of disease progression, need for treatment and overall mortality was documented.
  
  
  RESULTS
  Two hundred and forty-six Stage A0 CLL patients were identified. One hundred and five (43%) patients were discharged to primary care, whilst 141 (57%) patients were followed up in haematology outpatient clinics. No difference in mortality or need for treatment was found between the two groups. Of those discharged, 93 (66%) remained in primary care.
  
  
  CONCLUSIONS
  The management of stable-stage A0 CLL within primary or secondary care leads to equivalent clinical outcomes. The prevalence of early-stage CLL is expected to increase with the ageing population and management within primary care should be considered as a potentially effective approach.
authors: From the Cancer Sciences.
authors: H M
authors: HM
authors: Parry
authors: School of Primary Care Clinical Sciences.
authors: S
authors: S
authors: Damery
authors: School of Medicine and Dentistry, University of Birmingham, Edgbaston, West Midlands B15 2TT, UK.
authors: N P
authors: NP
authors: Mudondo
authors: From the Cancer Sciences.
authors: P
authors: P
authors: Hazlewood
authors: From the Cancer Sciences.
authors: T
authors: T
authors: McSkeane
authors: Centre for Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, West Midlands B9 5SS, UK and.
authors: S
authors: S
authors: Aung
authors: Centre for Clinical Haematology, Morris House, Queen Elizabeth Hospital, Birmingham, West Midlands B15 2TH, UK.
authors: J
authors: J
authors: Murray
authors: Centre for Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, West Midlands B9 5SS, UK and.
authors: G
authors: G
authors: Pratt
authors: From the Cancer Sciences.
authors: P
authors: P
authors: Moss
authors: Centre for Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, West Midlands B9 5SS, UK and d.w.milligan@bham.ac.uk.
authors: D W
authors: DW
authors: Milligan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000401:mortality* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients; D011320:Primary Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
references: Br J Haematol. 2012 Feb;156(4):499-507
references: 22171799
references: Cancer. 1981 Jul 1;48(1):198-206
references: 7237385
references: Leuk Lymphoma. 2011 Mar;52(3):429-35
references: 21323523
references: Eur J Intern Med. 2013 Jul;24(5):401-10
references: 23583413
references: Cancer. 2010 Oct 15;116(20):4777-87
references: 20578179
references: Blood. 2016 Oct 27;128(17):2109
references: 27789434
references: Am J Hematol. 2014 Jul;89(7):743-50
references: 24711230
references: Eur J Cancer Care (Engl). 2012 Jan;21(1):67-77
references: 21883563
references: Hematology Am Soc Hematol Educ Program. 2007;:324-31
references: 18024647
references: J Natl Cancer Inst. 1999 May 19;91(10):861-8
references: 10340906
references: Am J Hematol. 2013 Sep;88(9):803-16
references: 23720127
references: Br J Haematol. 2012 Dec;159(5):541-64
references: 23057493