Management of Lightheadedness and Dizzy Spells in CLL with Myeloid Sarcoma

Immediate Assessment Required

The American Society of Hematology recommends obtaining a complete blood count with differential to assess for worsening anemia or thrombocytopenia, which are common CLL complications that can cause dizziness and represent treatment indications 1, 2
Anemia causing symptoms or thrombocytopenia warrant immediate intervention, as these indicate progressive disease requiring treatment 1
If autoimmune cytopenias are identified, the European Society for Medical Oncology recommends initiating corticosteroids as first-line therapy 3, 2

The International Workshop on Chronic Lymphocytic Leukemia (IWCLL) criteria assess for treatment indications, including progressive lymphocytosis, massive lymphadenopathy, massive splenomegaly, or constitutional symptoms, which may explain the dizziness 1
The American Society of Clinical Oncology recommends considering Richter transformation if there is rapid clinical deterioration, new B-symptoms, or rapidly enlarging lymph nodes, as this carries a very poor prognosis and requires different management 6, 2

The European Hematology Association recommends bone marrow aspirate and biopsy for cytopenia of uncertain cause 5, 1
If autoimmune: corticosteroids are recommended as first-line; if refractory, consider rituximab or anti-CD20 antibody-based CLL treatment 3, 2
If disease-related: initiate CLL-directed therapy based on TP53/del(17p) status and IGHV mutation status 3, 7

The Infectious Diseases Society of America recommends administering appropriate antimicrobials for a full 10-day course minimum 4
Consider prophylactic antibiotics, antivirals, or antifungals for patients with recurrent infections 2
Evaluate for IV immunoglobulin replacement if severe hypogammaglobulinemia with repeated infections 4, 2