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Watch and Wait

Not all CLL patients need to start treatment immediately. “Watch and wait” is a valid treatment approach that means your doctor will watch your condition but not give you treatment unless you have signs or symptoms that appear or change. This approach includes: 

  • Regular medical examinations that include checking the size of your lymph nodes and spleen 
  • Regular blood testing to determine whether the disease is stable or beginning to progress 

You may think you should start treatment right away. But for people with low-risk (slow-growing) disease and no symptoms, it is often best not to start treatment immediately. With a watch-and-wait approach, you avoid the side effects of therapy until it is needed.  

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, clinical trials have not shown that there are any benefits of early treatment in terms of survival. 
  • Several studies have confirmed that patients with early-stage CLL do not benefit from the use of alkylating agents or aggressive chemotherapy, and these treatments do 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. 

Between appointments, if you notice that you are having frequent infections, increased fatigue, night sweats, or you are generally not feeling well, contact your doctor. Do not wait for your next appointment to report these symptoms. 

Learn more about watch and wait.  

When to Start Treatment

Some people with CLL can be managed with a watch-and-wait approach for years before the disease progresses. The decision to begin treatment is based on a patient’s symptoms, test results, and the stage of CLL. A patient may begin treatment if they have one or more of the following factors: 

  • An increase in the number of CLL cells 
  • A decrease in the number or red blood cells 
  • A decrease in the number of platelets  
  • An increase in the size of the spleen and/or the liver 
  • The presence of CLL symptoms including: 
  • Fatigue 
  • Night sweats 
  • Unexplained weight loss 
  • Low-grade fever 


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