CLL Support Association
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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,


1 like

Neil and Ernest:

Thank for a prompt and clear reply.



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