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Considerations in the frontline treatment of chronic lymphocytic leukemia.

SO The standard approach to CLL is still watch-andwait. If patients are asymptomatic and have minimal disease, we do not intervene. This approach is based on the fact that approximately a third of patients with CLL will never need treatment. The idea behind watch-and-wait is to spare those patients who would never require therapy. We begin frontline treatment when patients develop problematic symptoms related to the disease, such as bulky lymph nodes, anemia, or low platelets. My first choice for the management of patients with CLL is always to enroll them in a clinical trial. We cannot advance the science without enrolling patients on clinical trials.