A common question is “what is my number?” So, you know, and we don't treat numbers right. So you're white count maybe 20,000, 30,000, 50,000, 120,000 or 300,000. And by itself, it's not really a definition that you need therapy. It’s really understanding the disease burden. What is the disease causing? So usually if you have a white count  of 200,000-300,000, it’s more likely you’re going to need therapy but is probably a bigger burden of disease, There's a greater chance that the disease is affecting the marrow function or there's just more metabolically active and you start really impacting your lifestyle, then you need therapy. So the indications for treatment are based on symptoms. Again, as we talked before, if the disease is causing trouble, disease causing trouble, we will treat it. But a disease is there and the numbers just look a little off. We may treat, we may not. And for example, I just saw a patient yesterday. They came to see me because they’ve had a platelet count, always hanging around 110,000-120,000 and we know that one of the criteria for treatment of the platelet count is less than 100,000. So there was one single blood drop that probably had a little viral infection happening and is platelet count was 80,000. And he was indicated treatment and he came back and said, let's just look at this a little bit more carefully. And then we repeated the the the blood count yesterday and the and the platelet count was up around 110,000 again. So we don't treat numbers. We have to put everything together and understand really what is happening. So numbers are important. Numbers guide us, numbers help us understand what is happening. But we have to put together physical examination, what the patient is feeling, and what labs are doing before we decide if a patient needs therapy or not. So, many patients that I talked to
are surprised. First, they're surprised to learn they have a disease. Leukemia is a scary word.  Cancer is a scary word, because in some cases they  haven't been feeling sick. It's just something that is found on bloodwork. And then there can be a bit of whiplash when they find out that we're not going to treat it, or at least not right away. That's a very common thing is to have asymptomatic CLL, where you feel fine and CLL where the important blood cells, the red blood cells, the platelets, the cells that you need to have to function and be healthy are unaffected, are at normal levels. And that therefore these extra cells, these cancerous cells that you have seem to be just playing nice with everything around them. In cases like that, there's a very clear  consensus—experts agree on this. We do not need to start treatment right away. And some people find that a hard thing to feel okay about, that they have this disease. There is something wrong. This is abnormal, and we're just going to leave it there. But as you go along and you know, some of these patients over long periods of time and you see that they feel good, they can live a normal life, They don't have to deal with any of the inconveniences or any of the side effects that going on treatment can bring. And it's really just a better approach. And the reason that makes sense is, this is not a disease that we can ever really get rid of. There are extreme treatments that potentially can be cures for CLL, but but they're, they generally cause much more harm than they do good. In most situations, the goal with CLL is to have it not threaten your life or your health in any way,and then to forget that it's there for the most part. Watch over it. If needed, treat it to control it. But to ultimately live with it.