How Your Doctor Decides Your Treatment for Adult Chronic Lymphocytic Leukemia (CLL)

Researchers are continually finding new treatment methods for chronic lymphocytic leukemia (CLL), and people diagnosed with the disease now have more hope for survival than ever before.

The choices that you have for treatment depend upon these factors.

• Results of your lab tests

• Status of your health

• Your age

• Your personal needs or special considerations

Your choice of treatment also depends on these specific things about your leukemia.

• Stage of your disease

• Your blood counts

• Your symptoms

• Condition of your liver, spleen, and lymph nodes

Stages of CLLCLL is the only type of leukemia that is divided into stages. The staging system most commonly used in the U. S. is the Rai system described here. In general, the lower your stage, the more favorable your prognosis is.

• Stage 0: low-risk CLL. The blood lymphocyte count is too high (called lymphocytosis). This is usually defined as over 10,000 lymphocytes/mm3 of blood, but some doctors will diagnose CLL if the count is over 5,000/mm3 and the cells all have the same chemical pattern on special testing. The lymph nodes, spleen, and liver are not enlarged and the red blood cell and platelet counts are close to normal levels.

• Stage I: intermediate-risk CLL Lymphocytosis is found along with enlarged lymph nodes. The spleen and liver are not enlarged and the red blood cell and platelet counts are close to normal levels.

• Stage II: intermediate-risk CLL Lymphocytosis and an enlarged spleen (and possibly an enlarged liver) are found, with or without enlarged lymph nodes. The red blood cell and platelet counts are close to normal levels.

• Stage III: high-risk CLL. Lymphocytosis and anemia (too few red blood cells) are found, with or without enlarged lymph nodes, spleen, or liver. Platelet counts are close to normal levels.

• Stage IV: high-risk CLL. Lymphocytosis and thrombocytopenia (too few blood platelets) are found, with or without anemia, and with or without enlarged lymph nodes, spleen, or liver.

The prognosis is very good for stage 0. Usually treatment does not begin unless you have symptoms. Frequent follow-up is necessary. If you are in any of the other stage groups, you also may not need treatment unless you have symptoms.