Table 1 2018 International Workshop on CLL (iwCLL) guidelines on indications for treatment [7].

From: Chronic lymphocytic leukemia treatment algorithm 2022

Parameter

iwCLL indications for treatmenta

Lymph nodes

Massive (i.e.,≥ 10 cm), progressive, or symptomatic

Liver and/or spleen size

Massive (i.e.,≥ 6 cm below the left costal margin), progressive, or symptomatic

Constitutional symptoms

Disease-related symptomsb

Circulating lymphocyte count

Progressive ≥ 50% over a 2-month period, or lymphocyte doubling time < 6 monthsc

Platelet count

Worsening thrombocytopenia < 100 x 109/L due to progressive marrow failured

Hemoglobin

Worsening anemia < 10 g/dL due to progressive marrow failured

Bone marrow

Progressive marrow failure as per above

Extranodal

Symptomatic or functional extranodal involvement (e.g., skin, kidney, lung, spine)

  1. aAutoimmune complications (including autoimmune cytopenias) poorly responsive to corticosteroids or current treatment may represent an additional indication for change in treatment.
  2. bUnintentional weight loss ≥ 10% within the previous 6 months; significant fatigue (ECOG performance scale ≥ 2), fevers (38.0 °C) for ≥ 2 weeks without evidence of infection; night sweats for ≥ 1 month without evidence of infection.
  3. cNon-CLL factors that may contribute to lymphocytosis (e.g., infections and corticosteroids) should be excluded.
  4. dHemoglobin and platelet count cutoffs require consideration of the rate of decline. In certain patients, counts slightly below these levels may remain stable for an extended period and not require treatment initiation.
Back to article page