Some people can manage their chronic lymphocytic leukemia (CLL) with their doctors for years with observation (watch-and-wait). By using the watch-and-wait method, your doctor can monitor your condition with regular physical exams and lab tests. You won't take any drugs or undergo any CLL treatment during this period. This approach includes
- Medical examinations
- Periodic testing to determine whether the disease is stable or beginning to progress
- Counseling by their doctors to seek medical assistance if they develop fevers or other signs of infection or illness
- Active treatment is started when, or if, the disease begins to progress.
You may feel uncomfortable because you know that you have cancer, yet you're not being treated right away. The watch-and-wait approach is the standard of care for people who have low-risk (slow-growing) disease with minimal changes in their blood counts and no symptoms. The watch-and-wait approach lets you avoid therapy's side effects until you need treatment. Many studies have compared the watch-and-wait approach to an early treatment approach for people with low-risk CLL. Study findings include the following information:
- To date, no benefits of early treatment for people with low-risk CLL have been shown.
- Several studies have confirmed that the use of alkylating agents or aggressive chemotherapy in patients with early-stage disease does not prolong survival.
- There are risks of early treatment, including potential side effects and treatment complications.
- Patients may build up a resistance to the drugs used and would not be able to use them again when treatment for progressive disease is necessary.
Deferred treatment versus early treatment for people with CLL who are symptom-free is an area of ongoing study in clinical trials.
Many patients take alternative medicines during this time period. The active ingredient of green tea (EGCG) has been studied preliminarily as a therapy to prevent CLL progression and has shown very modest results but reasonable safety. Other agents have not been studied extensively in this area. Patients should discuss taking such alternative medications with their doctors.
You must visit your doctor regularly so he or she can check you for any health changes, specifically watching whether your disease remains stable or starts to progress. Your doctor monitors your test results to decide when it's time to start treatment and what the best treatment option is for you.
When to Begin Treatment
Your doctor may advise you to begin treatment if one or more test results show the following when compared with your prior test results:
- A relatively rapid increase in the number of lymphocytes in your blood
- A decrease in the number of platelets in your blood
- Lymph nodes that are getting larger
- A spleen that's increasing in size
- Worsening anemia
- CLL symptoms (such as fatigue, night sweats, weight loss, fever, etc)
Several of these factors are often present at the same time.