| A. "KLL is cancer." |
TRUE |
CLL/SLL is a malignant B-cell neoplasm in the WHO classification. Every Swedish case must be reported to the national cancer quality registry; precursor MBL, by contrast, must not be reported as cancer. It is usually lifelong and not cured by standard treatment. Infection contributes to 25–50% of CLL deaths. Many cases are indolent, but "indolent" does not mean "harmless" |
WHO-HAEM5; VP8.2 ch. 1 and §7.4; 1177 |
| B. "Most patients do not need treatment immediately." |
TRUE |
About 85% need no treatment at diagnosis (VP8.2). In 2020–2024, registry data show only 10% were treated at diagnosis. Early treatment has never improved survival |
KLL registry 2025; VP8.2 ch. 10 |
| C. "Some patients never need treatment." |
TRUE (exact share uncertain) |
VP8.2 says "cirka en tredjedel" (about a third), an estimate with no registry figure behind it. The patient leaflet implies 35–40%. In a French trial, 49% of untreated stage A patients had neither progressed nor been treated after more than 11 years |
VP8.2 ch. 10; Dighiero 1998 |
| D. "A patient with KLL can often continue exercising normally." |
TRUE |
Swedish and EHA guidance encourage activity whether or not the patient is treated. Real restrictions apply only in specific situations: infection, very low platelets, an enlarged spleen, contact sport on a BTKi, and hydration during venetoclax ramp-up. Exercise improves fatigue and fitness. It has not been shown to change the course of CLL, and fitness is not a prognostic sign |
VP8.2 §18.6, §19.1.3; VP Cancerrehabilitering |
| E. "Modern treatment has dramatically improved KLL outcomes." |
MOSTLY TRUE |
Swedish 5-year relative survival after starting treatment rose from 57% to 84% between 2007–2011 and 2020–2024. Several randomised trials show OS benefits over chemoimmunotherapy (E1912, ELEVATE-TN, GLOW, FLAIR). TP53-aberrant disease went from a median survival of 2.5–4 years to 4–5-year OS of about 82–88%. But the newest registry figures are immature, and modern treatment is not curative. For untreated early disease, survival depends mostly on other factors, and early treatment adds nothing |
KLL registry 2025; E1912; ELEVATE-TN |
| F. "Fixed-duration targeted treatment is now a major first-line option in Sweden." |
TRUE |
VP8.2 recommends VO for 12 months or AV for 14 months "i första hand" (as first choice, +++) when TP53 is intact. Both are subsidised. Chemoimmunotherapy was only 25% of first-line treatment in 2020–2024. With TP53 aberration, continuous BTKi is preferred instead |
VP8.2 §11.2.1 |
| G. "TP53/del17p and IGHV should be known before selecting therapy." |
TRUE |
Required by VP8.2, iwCLL ("Always"), EHA (II, B) and the ICC. TP53 must be retested before every line of treatment; IGHV is tested once. These are the only markers that change first-line choice |
VP8.2 §8.2; EHA 2026 |
| H. "Lund is one of the strongest places in Sweden for CLL evaluation." |
MOSTLY TRUE (cannot be proven) |
SUS Lund has the region's designated CLL clinicians, in-house accredited FISH and TP53 testing, in-house IGHV testing (not flagged as accredited), haematopathology, Skåne's only first-line CLL trial site (CLL18) and a transplant centre. But national CLL research and trial depth is greater at Karolinska and Uppsala, Lund's laboratory holds no ERIC certification, and the registry shows no significant regional differences in survival after treatment. "Strongest" cannot be measured |
VP8.2 ch. 25; CTIS CLL18; KLL registry 2025 |
| I. "A Swedish cancer patient can request a formal second medical assessment." |
TRUE |
Patientlagen 8 kap. 1 § and HSL 10 kap. 3 § give this right, and 1177 names cancer as a qualifying example. Caveats: the provider judges whether the disease is serious enough; there is no right to a specific doctor; any resulting treatment is conditional on evidence and cost; travel is reimbursed only if the referral is marked correctly |
Patientlag; 1177 |