Your first appointment at Fred Hutchinson Cancer Center is a time for you and your hematologist-oncologist to meet. You might meet your advanced practice provider, too. You will talk about your diagnosis, disease outlook and likely treatment. This visit is also a time for us to start getting to know you as a person. This helps us fit our recommendations to you. Together, you and your care team will decide what needs to happen next.
We encourage you to bring a family member or friend to your first appointment (and any future visits).
What to Expect
Your first appointment usually lasts about one hour. Here’s what you can expect to happen.
Most of our new patients have already had blood tests that show they have chronic myeloid leukemia (CML). Many were recently diagnosed. Others have had CML treatment elsewhere and are looking for new options. If you haven’t had the blood tests you need, we may ask you to come in for these before your first appointment.
We start by checking your diagnosis. An experienced Fred Hutch hematopathologist looks carefully at your pathology slides. Knowing details about your CML is important because it helps your doctor predict how your disease might behave and which treatments will likely work best for you.
Our hematopathologists may run more tests on your blood or bone marrow to confirm your diagnosis or look for features of your CML that matter for your care. At your first appointment, your doctor will have your results and go over them with you.
Your doctor will explain what CML is and how it typically behaves over time. They will talk with you about how the disease is affecting your body, and they will describe what happens for most people in your situation with or without treatment.
Doctors group CML into three phases — chronic, accelerated and blast — based mainly on the percentage of immature white blood cells (blasts) in the blood and bone marrow. Knowing the phase helps your team choose the best treatments for you. Your doctor will explain what your CML phase means.
Most new patients are in the chronic phase. In this phase, the percentage of blasts is abnormal but low. In the accelerated phase, the percentage is higher, and you might have other signs and symptoms. In the blast phase, the percentage is even higher, and the disease acts more like acute leukemia.
The goal of CML care is to give you a normal lifespan with the best possible quality of life. The treatment we recommend for you will depend on your CML phase and many other things, like your age and health. If your CML has already been treated elsewhere, we will also consider which therapies you had, how your disease responded and if you had side effects.
Based on your test results so far (and any previous treatment), your doctor will explain the treatments you are likely to need. If you need any other tests to tell us more about your disease, we will talk about your treatment again in more detail after we have the results.
These appointments are also a time for you to tell us about yourself. Each patient and family has their own needs and preferences. We want to get to know you so we understand the best way to care for you.
Starting with your first appointment (and after), we are here to answer your questions. We want to help you understand as much as you want to know about your disease, your treatment and how care happens at Fred Hutch. We invite you to bring a friend or family member with you to help keep track of your questions and the information that your team gives you.
We also encourage you to talk with your care team about your hopes and concerns. Knowing more about you helps your team recommend the right treatment for you.
Before you leave, we will make sure you know what is going to happen next and how you can reach us if you have questions later. We will also schedule your next visit.
Tests for CML
To diagnose CML, figure out the phase of your disease, predict the outlook, plan your treatment and check how well treatment works, we will need to do blood and bone marrow tests and imaging tests.
Blood and marrow tests show your levels of healthy blood cells and leukemia cells. They also give us details about your leukemia cells that affect your treatment plan. Imaging tests provide information about how CML is affecting your organs.
Blood tests for CML include:
- Complete blood count (CBC)
- Blood chemistry
- Peripheral blood smear
- Cytogenetic tests
- Fluorescence in situ hybridization (FISH)
- Polymerase chain reaction (PCR)
After numbing the area so there is no pain, a doctor uses a hollow needle to take a sample of marrow (bone marrow aspiration) and a small piece of bone (bone marrow biopsy). A pathologist checks these samples for signs of cancer. Many of the same tests done on your blood can also be done on your marrow.
Imaging tests that we use to check if CML is affecting your organs include:
- CT (computed tomography) scan
- MRI (magnetic resonance imaging)
Resources for Patients and Caregivers
Here are tips about how to prepare for your first appointment at Fred Hutch and what to bring.
Just like every patient’s situation is different, every caregiver may be asked to help with different tasks. Learn how you can offer support during a first visit.
As a caregiver, you can give your loved one both emotional and practical support for their first appointment. Ask them if you can help with things like these:
- Helping them manage their stress, worry or other feelings.
- Planning how to get to and from the appointment, what time to leave home and where to park.
- Making a list of questions they want to ask the physician. Fred Hutch’s Guide to Your Care (PDF) has a list of questions they may want to ask the care team. At the appointment, make sure that all their questions get answered.
- Taking notes during the visit. The physician will be giving a lot of details, which can be hard to remember later without notes.