What we know and what we do not: the decisive facts are still missing¶
Five facts are known: J lives in Skåne; he was first told he had a cancer involving lymph nodes; two nodes were surgically excised for pathology; he reports the diagnosis as "KLL, kronisk lymfatisk leukemi"; and he is physically active and wants to question assumptions and obtain a second opinion. Almost everything that determines management is unknown. Two consequences follow.
- [I] The pathology report carries unusual weight. Diagnosis by lymph-node excision is the less common route: in Sweden, 73% of patients diagnosed in 2020–2024 were diagnosed on blood alone, against 41% in 2007–2008 (KLL registry report 2025, p. 21) [E].
- [I] His fitness says nothing about the biology of his disease. Being able to exercise is not a prognostic signal. CLL exercise studies show benefits for fitness and fatigue but say nothing about progression or survival (section 11).
| Item | Status | Why it matters | Where it comes from |
|---|---|---|---|
| Region of residence (Skåne) | Known | Determines clinics, referral rules, vaccine costs and travel rules | — |
| Reported diagnosis "KLL" after excision of two nodes | Known, wording unverified | CLL, SLL and tissue-MBL are managed differently in registries and trials | Written diagnosis; PAD |
| Physically active | Known | Shapes treatment trade-offs (bleeding, AF, infusions); not prognosis | — |
| Wants a second opinion | Known | Statutory route exists (PL 8 kap. 1 §) | Section 16 |
| Pathology details (proliferation centres, Ki-67, large cells, MCL exclusion) | Unknown | Separates typical CLL/SLL, accelerated CLL, Richter transformation and look-alike lymphomas | PAD, IHC addenda |
| Blood clonal B-cell count (flow cytometry) | Unknown | ≥5×10⁹/L = CLL; <5 with nodes = SLL | Blood flow-cytometry report |
| Blood counts: Hb, platelets, lymphocytes, differential, reticulocytes | Unknown | Binet C, treatment criterion "marrow failure", autoimmune cytopenias | Lab history |
| Stage (Binet/Rai) | Unknown; cannot be inferred from node involvement | Staging uses palpable areas and blood counts only | Clinical examination |
| Imaging and spleen size | Unknown | Bulky/massive disease criteria; TLS risk if venetoclax is ever used | Radiology reports |
| Symptoms (fever, night sweats, weight loss, fatigue) | Unknown | Treatment criterion | Doctor's notes |
| TP53/del(17p), FISH panel, IGHV | Unknown | Treatment selection and prognosis | Genetics reports (often only before treatment in Sweden) |
| Age, heart, kidney and other comorbidities; medications | Unknown | Drug choice, interactions, vaccine eligibility, prognosis | Records, medication list |
| Immunoglobulins, infection history, hepatitis B status | Unknown | Infection risk, prophylaxis, vaccination | Labs |
| Owning clinic, SVF status, proposed plan | Unknown | Who is accountable | Ask the clinic |