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Psychological distress may have biologic implications given that natural killer [NK] cells, T cells, and monocytes are not only sensitive to distress, but also critical in controlling disease progression. Therefore, the objective of this study was to explore associations of distress with immune biomarkers in patients with CLL\/SLL being managed by active surveillance. We enrolled 76 participants and assessed perceived stress, anxiety, and depressive symptoms at study entry and every 6\u2009months for up to 2\u2009years during active surveillance. Blood samples were collected at the same time points to assess biomarkers on T cell, NK cell, and monocyte subsets. In multivariable regression analyses, higher levels of perceived stress and anxiety were significantly associated with lower percentages of intermediate monocytes (IM); anxiety was also significantly associated with higher percentages of classical monocytes (CM). In longitudinal analyses, higher stress and anxiety were significantly associated with higher percentages of CM at 12\u2009months. This is one of the first studies to observe that psychological distress is associated with differential patterns of monocyte distribution in patients with CLL\/SLL managed with active surveillance.<\/jats:p>","DOI":"10.1002\/cam4.71903","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T05:05:07Z","timestamp":1778907907000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating Associations Between Psychological Distress and Changes in Peripheral Blood Monocytes in Patients With\n                    <scp>CLL<\/scp>\n                    \/\n                    <scp>SLL<\/scp>\n                    Managed With Active Surveillance"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0575-3867","authenticated-orcid":false,"given":"Carolyn Y.","family":"Fang","sequence":"first","affiliation":[{"name":"Fox Chase Cancer Center, Temple University Health System  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1740-4848","authenticated-orcid":false,"suffix":"IV","given":"Alexander W.","family":"MacFarlane","sequence":"additional","affiliation":[{"name":"Fox Chase Cancer Center, Temple University Health System  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry C. 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