This patient will require chemotherapy
|A||If the white blood cell count rises|
|B||If lymphadenopathy develops|
|C||To control anemia or thrombocytopenia|
|D||Only when acute lymphocytic leukemia develops|
To control anemia or thrombocytopenia
The commonly used Rai staging system for CLL begins with stage 0 (low-risk) CLL, which is associated with peripheral lymphocytosis alone. The patient with peripheral lymphadenopathy alone is at stage I. The presence of splenomegaly puts the patient in stage II (stages I and II are considered intermediaterisk). Stage III patients have an associated anemia, while stage IV is associated with thrombocytopenia (patients at stage III and IV are at high risk of complication and have a median survival of 1.5 years). Early treatment of CLL does not improve survival, and so treatment is usually reserved for symptomatic disease (bulky lyphadenopathy or splenomegaly) or high-risk disease (anemia and thrombocytopenia). Antimetabolites such as fludarabine and the alkylating agent chlorambucil are cornerstones of treatment. Steroids and immunoglobulin replacement may be used in patients with autoimmune cytopenias or symptomatic hypoglobulinemia (respectively).