Kanti R Rai and Bhoomi Mehrotra

The answer to the question of when to initiate cytotoxic therapy in a patient with chronic lymphocytic leukemia (CLL) has been modified and refined in the past 5 years, and to some extent that process of "refinement" is, perhaps, still an ongoing one.1


CLL is one of the few hematologic malignancies in which it is advisable not to start treatment merely because a patient has just been diagnosed with this disease. Except for circumstances when, at the time of diagnosis, certain unusual clinical findings are present (discussed below), patients with CLL are initially followed on a "wait and watch" basis.2

A newly diagnosed patient without symptoms, and in whom the disease was discovered because of a routine (or yearly) medical checkup, or accidentally in the process of investigations of unrelated problems, is kept under observation, and is asked to return to the clinic at 3-month intervals for re-evaluation.2

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