Drs. Alvaro Alencar with the Miami Sylvester Comprehensive Cancer Center and Matthew Butler with the MD Anderson Cancer Center share when a CLL patient should start treatment. Watch their interview below:

The Impact of Blood Counts

A common question among CLL patients is "What is my number?" Whether it's a white blood cell count, platelet count, or any other blood count, patients often seek to find a concrete answer that defines the disease. However, when it comes to interpreting these numbers and deciding on appropriate treatments, CLL specialists emphasize the importance of looking beyond the figures. 

Blood counts, such as white blood cell counts, are crucial indicators that help doctors assess a patient's health and identify potential diseases. These counts can range widely, from 20,000 to 300,000 or more, but the numbers alone do not tell the full story. Rather, it is the underlying disease burden and its impact on the individual that determine the need for therapy.

For instance, a white blood cell count in the range of 200,000 to 300,000 may indicate a larger disease burden, suggesting that therapy is more likely necessary. This could be due to the disease affecting bone marrow function or being more metabolically active, leading to potential disruptions in the patient's lifestyle. On the other hand, if the disease is not causing any trouble and the numbers are only slightly off, treatment may not be immediately required.

Factors of Treatment Decisions

Treatment decisions are not solely based on numbers; rather, they take into account the patient's symptoms, physical examination, and overall well-being. A patient may have a blood count that falls below the criteria for treatment, but if they are experiencing symptoms or complications related to their condition, therapy may still be considered. 

CLL is a type of cancer that can be without symptoms (meaning patients may not feel sick despite the presence of the disease). In such situations, CLL specialists agree that immediate treatment may not be necessary, especially if other important blood cells (e.g., red blood cells and platelets) remain unaffected and at normal levels.

While it can be concerning for CLL patients to learn they have cancer, their CLL specialist will carefully weigh the risks and benefits of treatment for the patient to help provide the best outcome.  In cases where CLL is not threatening the patient's life or health, the watchful waiting approach is often recommended. This involves monitoring the disease over time and initiating treatment only if it becomes necessary to maintain control. 

Patients may initially find it challenging to accept the notion of living with a disease without immediate treatment. However, as they experience good health and normalcy in their daily lives, the rationale behind the watchful waiting approach becomes clearer.

The current treatment goal CLL specialists aim for is to help the patient have as normal a life as possible and limit any unnecessary medical interventions. Although the disease may be present, it can often be managed with targeted therapies (venetoclax and/or BTK inhibitors) to help the patient maintain a good quality and extended length of life.