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What chronic lymphocytic leukemia patients need treatment right away?
Posted by
HealthTree • March 19, 2025
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What patients need treatment right away? One of the unique things about chronic lymphocytic leukemia is that every patient's disease course is a little bit different. And so approximately a third of patients will actually never need treatment for their CLL. A third of patients need treatment right away at the time they're diagnosed with CLL. Another approximate third don't need treatment right away when they're first diagnosed, but will need treatment at some point in the future. So one of the biggest decisions I think that a CLL patient and their doctor faces together is when is treatment indicated? So we have a set of criteria that tells us, it's called the IW-CLL criteria, and your doctor will use this to determine whether treatment is indicated. And very simply put, what I tell patients is we don't treat the CLL until it's causing a problem because there's actually been studies in the past in clinical trials that have been done to see if early treatment impacts overall survival, and so far it hasn't. There's a couple of ongoing studies looking at newer ways to do early treatment, but so far the standard is to start treatment when the CLL is causing a problem. So that can mean different things for different people. So the white blood cell count in and of itself being high is never our reason alone to start treatment. So it has to be the white blood cell count plus something else. And the white blood cell count can be anywhere from near normal range, just a little abnormal, to into the 200,000 range. The CLL can affect the hemoglobin or the platelet count. So these are other cells made by the bone marrow, your red blood cells or your platelets. If those are decreased, that can be a reason to start treatment. Some patients get big lymph nodes that are bigger, bulky, for example, coming out of the neck or near an organ like the kidney or liver. So if lymph nodes get to a size, they can start to affect that or they can cause a patient's symptoms. And then some other patients get symptoms like fevers, drenching night sweats, fatigue from the CLL that we do an investigation to find out if there's another medical issue that's causing this. And if we don't find anything, then that actually can be a conversation with your doctor to start treatment. So it can be a little bit different for every patient, but those are the main criteria that you and your doctor will go through to determine if treatment is indicated.


