NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia
23 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 2 Treatment planning Starting treatment Starting treatment Part of treatment planning involves deciding when to start treatment. Not all people with CLL need to start treatment right away. Starting treatment is based on symptoms of CLL, test results, and the cancer stage. The cancer stage is a rating by your doctors that suggests what the prognosis of the cancer is. The Rai staging system will help your doctor decide whether to start treatment or not. This system consists of five cancer stages. The cancer stages are defined by the results of your physical exam and blood tests. The five stages are: Stage 0 is defined by normal test results except for a high number of lymphocytes in blood. The likelihood of the cancer getting worse is low. Stage I is defined as a high number of lymphocytes in blood and enlarged lymph nodes. The likelihood of the cancer getting worse is intermediate. Stage II is defined by an enlarged liver, spleen, or both. The likelihood of the cancer getting worse is intermediate. Stage III is defined by a low hemoglobin level. The likelihood of the cancer getting worse is high. Stage IV is defined by a low platelet count. The likelihood of the cancer getting worse is high. You may hear of the Binet staging system. It is another system used to stage CLL. It has three stages labeled A, B, and C. The stages are based on your physical exam and blood tests. The Binet system may be helpful for prognosis but isn’t used in this book to decide starting treatment. If you have Rai stage 0, I, and II CLL, treatment may not be needed now. You should be further assessed to learn if treatment is needed. Signs to start treatment include: Symptoms of active CLL, such as drenching night sweats Severe fatigue Fever without proof of infection Unplanned weight loss If these signs are not present, observation is advised. Treatment can be started when any of the listed signs appear or the cancer advances to stage III or IV. Most people with stage III or IV CLL need to be treated, even when newly diagnosed. In some cases, observation may be an option if your blood cell counts aren’t too low and don’t drop more. Treatment is advised if the cancer is stage III and IV and your blood cell counts are falling.