When To Initiate Cytotoxic Therapy

The method we have used in our clinic for deciding to institute therapy in a CLL patient who has been under observation since the initial diagnosis is based on any of the following features:

1. Development of symptoms attributable to CLL.

2. Evidence of progressive increase in the extent of disease.

3. Development of disease-related complications.

"USUAL" SYMPTOMS ATTRIBUTABLE TO CLL

In CLL, the usual disease-related symptoms are the same as "B" symptoms found in lymphomas2: profound night-sweats; weight loss (10% or more from usual weight over 6-12 month period) without trying; fever without overt infections and extreme fatigue. Emergence of any of these symptoms in a previously asymptomatic patient is an indication for therapy.

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