title: [Chronic lymphocytic leukemia: when to start a specific treatment?].
abstract: This paper reviews the literature to propose guidelines for managing patients with early-intermediate stage chronic lymphocytic leukemia (CLL). Clinical and biological parameters are sufficient to identify a cohort of patients with high-risk CLL at diagnosis who will have disease progression: anemia (Hb < 100 g/l) or thrombocytopenia (platelets < 100 G/l), bone marrow infiltration (> 30% lymphocytes), a rapid doubling time (less than 6 months) or lymphocytes above 300 g/L, splenomegaly and massive lymphadenopathy, systemic symptoms, uncontrolled autoimmune complications. Patients without those characteristics have low-risk CLL. In the absence of evidence of survival benefit in low-risk CLL, there is no indication for treatment and patients should be followed up by physical examination and complete blood count once or twice a year.
authors.affiliation: Service de médecine interne générale, HUG, 1211 Genève 14. samuel.blaser@hcuge.ch
authors.forename: Samuel
authors.initials: S
authors.lastname: Blaser
authors.forename: Jérôme
authors.initials: J
authors.lastname: Stirnemann
authors.forename: Monika
authors.initials: M
authors.lastname: Nagy
mesh_terms: D001772:Blood Cell Count / Q000379:methods; D018450:Disease Progression; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors