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Watch and Wait

People with CLL who have minimal changes in their blood counts and no symptoms are usually managed with the watch-and-wait approach, also called "active surveillance" or "watchful waiting." This includes

  • Regular medical examinations
  • Regular blood work to determine whether the disease is stable or beginning to progress.

People are often concerned when they receive a diagnosis of CLL and then learn that they will not begin treatment right away. When there are minimal changes to a person’s blood counts and no symptoms, the watch-and-wait approach is the current standard of care. 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.


When to Begin Treatment

Some people with CLL can be managed with a watch-and-wait approach for years before the disease progresses. The decision to treat a person with CLL is based on a number of factors that indicate the progression of disease. According to the International Workshop on Chronic Lymphocytic Leukemia (iwCLL) guidelines, the following conditions define active disease:

  • Extranodal (outside of lymph nodes) involvement in skin, kidneys, lungs and spine
  • Enlarging lymph nodes noted over a series of clinical exams
  • Enlarging spleen noted over a series of clinical exams
  • Evidence of progressive marrow failure by the development or worsening of 
    • Anemia (red blood cell count of less than 10 g/dL), and/or
    • Thrombocytopenia (platelet count of less than 100,000/uL) 
  • Autoimmune anemia and/or thrombocytopenia poorly responsive to standard therapy
  • Lymphocyte doubling time of less than 6 months, or progressive lymphocytosis with an increase of more than 50 percent over a two-month period
  • Presence of CLL symptoms
    • Fatigue
    • Night sweats
    • Unexplained weight loss
    • Low-grade fever. 



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