In those without or only minimal symptoms watchful waiting is generally appropriate.CLL is treated by chemotherapy, radiation therapy, biological therapy, or bone marrow transplantation. Symptoms are sometimes treated surgically (splenectomy – removal of enlarged spleen) or by radiation therapy ("de-bulking" swollen lymph nodes).Initial CLL treatments vary depending on the exact diagnosis and the progression of the disease, and even with the preference and experience of the health care practitioner. Any of dozens of agents may be used for CLL therapy. Decision to treat
While it is generally considered incurable, CLL progresses slowly in most cases. Many people with CLL lead normal and active lives for many years—in some cases for decades. Because of its slow onset, asymptomatic early-stage CLL (Rai 0, Binet A) is, in general, not treated since it is believed that early-stage CLL intervention does not improve survival time or quality of life. Instead, the condition is monitored over time to detect any change in the disease pattern.The decision to start CLL treatment is taken when there is evidence for progressive symptomatic disease (summarized as "active disease").Clinical "staging systems" such as the Rai four-stage system and the Binet classification can help to determine when and how to treat the patient.Determining when to start treatment and by what means is often difficult; no survival advantage is seen in treating people with asymptomatic early-stage CLL. The International Workshop on CLL (iwCLL) has issued guidelines with specific markers that should be met to initiate treatment. Chemotherapy
Combination chemotherapy regimens are effective in both newly diagnosed and relapsed CLL.
Or there is fever, night sweats, weight loss, and the person feels tired.CLL can be grouped with small lymphocytic lymphoma (SLL) as one disease with two clinical presentations. Wherein, with CLL, diseased cells propagate from within the bone marrow, in SLL they propagate from within the lymphatic tissue. CLLs are, in virtually all cases, preceded by a particular subtype of monoclonal B-cell lymphocytosis (MBL). This subtype, termed chronic lymphocytic leukemia-type MBL (CLL-type MBL) is an asymptomatic, indolent, and chronic disorder in which people exhibit a mild increase in the number of circulating B-cell lymphocytes. These B-cells are abnormal: they are monoclonal, i.e. produced by a single ancestral B-cell, and have some of the same cell marker proteins, chromosome abnormalities, and gene mutations found in CLL. CLL/SLL MBL consist of two groups: low-count CLL/SLL MBL has monoclonal B-cell blood counts of <0.5x9 cells/liter (i.e. 0.5x9/L) while high-count CLL/SLL MBL has blood monoclonal B-cell counts ≥0.5x9/L but <5x109/L. Individuals with blood counts of these monoclonal B-cells >5x9/L are diagnosed as having CLL. Low-count CLL/SLL MBL rarely if ever progresses to CLL while high-count CLL/SLL MBL does so at a rate of 1-2% per year. Thus, CLL may present in individuals with a long history of having high-count CLL/SLL MBL. There is no established treatment for these individuals except monitoring for development of the disorders various complications (see treatment of MBL complications) and for their progression to CLL.