Chronic Lymphocytic Leukemia
His doctor has told him that if the count reaches 100,000, then is the time to begin treatment.
Although the magnitude of the white blood cell count can be scary to some patients and even doctors, in general we do not usually need to treat patients because of a white blood cell count elevation alone. We usually look for other indications prior to making decisions about treatment in this disease.
We usually choose to treat patients with chemotherapy if and when they develop (1) low red blood cell or platelet counts (2) bothersome, dangerous or painful enlarged lymph nodes (3) large liver or spleen (4) bothersome fevers, chills, sweats or night sweats.
With respect to the white blood count, some physicians may choose to treat if the count is doubling rapidly, and at times just on the basis of the high white blood count (definitions of high differ greater than 100,000, 200,000, or 250,000).
Sometimes doctors may choose to give the patient treatments other than chemotherapy for some of these manifestations, such as steroids for a low platelet count or immunoglobulin treatment for frequent infections. Some patients receive radiation therapy for enlarged lymph nodes or large spleen.
We generally have talked about CLL as treatable, because in general we try to just keep the disease under control so that it does not cause any problems. Traditional therapies have not been shown to be able to get rid of the disease. However newer treatments and agents continue to become available and time will tell us if any of these succeed in actually getting rid of the disease in patients; something that would obviously be desirable if we could do so without too much risk or undesirable toxicity.