Treat the symptoms not the counts is an expression that is often used in the management of CLL. Indeed, the start of treatment is usually determined by a patient's symptoms. The types of symptoms that signal the start of treatment include, general lack of wellness, extreme fatigue, night sweats, low-grade fevers without any evidence of infection, significantly swollen lymph nodes, and frequent and recurrent infections. The aggressiveness of one's CLL along with their specific prognostic indicators will also be factors in selecting the time to begin treatment. Aggressive CLL will be treated sooner rather than later.

The decision to begin treatment is an important juncture in the CLL journey. As a general rule, one doesn't want to start treatment too early or wait too long. Selecting the right time to begin treatment and the type of treatment are very important decisions. Some patients prefer to leave these decisions entirely in the hands of their physicians, while others prefer to take an active role in determining both the timing and the selection of their treatments.

Following is a general outline of the types of treatments used in the various stages of CLL (see also: What are the stages of CLL?):

Stage 0 (elevated lymphocyte counts only) - Treatment is generally not needed.

Stage 1 (elevated lymphocyte counts and enlarged lymph nodes) - If the patient is without symptoms, treatment may still not be required. External radiation therapy to swollen lymph nodes and chemotherapy may also be considered.

Stage 2 (elevated lymphocytes, enlarged nodes, and liver or spleen enlargement) - If there are few or no symptoms, treatment may still not be required. Other possibilities at this stage include chemotherapy, external radiation to the spleen and/or lymph nodes, and clinical trials. (see also: What are clinical trials?)

Stage 3 (elevated lymphocytes and too few red blood cells; lymph nodes and liver or spleen may be enlarged) - Treatment at this stage may include any of the following: chemotherapy, external radiation to the spleen, surgery to remove the spleen (splenectomy), external radiation to the whole body (total body radiation), clinical trials of bone marrow transplantation, and clinical trials of biological therapy.

Stage 4 (elevated lymphocytes and too few platelets; lymph nodes, liver, or spleen may be enlarged, and there may be too few red blood cells) - The treatment options in stage 4 are much the same as stage 3.

Refractory CLL - Refractory means that the CLL initially or no longer responds favorably to treatment. The CLL may become refractory to a particular course of therapy in which case other therapies are used. If the CLL becomes refractory to all standard treatments, the patient's treatment options will depend on many factors. Two options that may be available to consider include entering a clinical trial of new chemotherapy, biological response modifier, or monoclonal antibody drugs and bone marrow transplantation.