Hb and platelet number for starting treatment

Hi everyone:

I found the following description of the paper on a criterion for starting treatment. However, this criterion seems not to refer Hb and platelet number. Just described ‘worsening of anemia and/or thrombocytopenia as you can see (1). Do anyone know criteria of Hb and the number of platelets to start the treatment? Hb < 11?, platelets < 100 ?


(1) Evidence of progressive marrow failure as manifested by the development of, or worsening

of, anemia and/or thrombocytopenia

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


(3) Massive nodes (i.e., >10 cm in longest diameter) or progressive or symptomatic


(4) Progressive lymphocytosis with an increase of >50% over a 2-month period, or lymphocyte

doubling time (LDT) of less than 6 months. LDT can be obtained by linear regression

extrapolation of absolute lymphocyte counts (ALC) obtained at intervals of two weeks over

an observation period of 2-3 months; patients with initial blood lymphocyte counts of less

than 30.000/μl may require a longer observation period to determine the LDT. Also, factors

contributing to lymphocytosis or lymphadenopathy other than CLL (e.g., infections) should

be excluded.

(5) Autoimmune anemia and/or thrombocytopenia poorly responsive to corticosteroids or other

standard therapy (see 10.2).

(6) A minimum of any one of the following disease-related symptoms must be present:

(a) Unintentional weight loss ≥ 10% within the previous 6 months.

(b) Significant fatigue (i.e., ECOG PS 2 or worse; cannot work or unable to perform

usual activities).

(c) Fevers of greater than 100.5° F or 38.0° C for 2 or more weeks without other

evidence of infection.

(d) Night sweats for more than 1 month without evidence of infection.

Thank you.


3 Replies

  • Hi Miee,

    If you look at the post on the Patient Power interview with Dr William WIerda, you'll find your answers:

    "If the hemoglobin drops below 10 or 11, that's when I start talking to patients about starting treatment. If the platelet count drops below 100, I start talking to them about treatment.'


    Generally, while CLL specialists start talking about treatment when platelets drop below 100, the point at which treatment really needs to start is 70.


  • Hi Miee,

    From my practical experience I can say that Hb around 10 or 11 is ok.

    Down to 7 or 8 does not feel good although can still walk slowley on the flat.

    I haven't had an issue with platelets although they are outside the ideal healthy range.

    Kind Regards,


  • Neil and Ernest:

    Thank for a prompt and clear reply.


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