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When Do White Count Numbers Trigger Treatment in CLL?

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Published on March 18, 2013

Dr. Susan Leclair, in her continuing series, answers a viewer question. She explains each patient's blood count numbers are different and the determination for when to start treatment is not tied to a specific white count number.

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Transcript | When Do White Count Numbers Trigger Treatment in CLL?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Now, remember, we want to hear from you.  You can always write us at comments@patientpower.info, and we did get a question for Dr. Leclair from Karen.  Karen was just recently diagnosed with B-cell CLL.  She’s trying to understand what the indications for treatment are, particularly in that white blood count number.

Karen’s Question:

I have just been diagnosed with CLL. My white cell count is 12,000, not too high. When will I begin to have symptoms that require treatment? I have B Cell CLL.

What percentage of people with B Cell CLL never have symptoms that need treatment?

Dr. Leclair:

So, Karen, that’s a great question, and I think everybody has it, so, there are lots of people out there listening, thanking you, for asking that question. 

The big issue here is that every good physician will tell you they do not treat numbers.  They treat people, and they don’t even treat groups of people.  They treat individual people.  So there will be people who, perhaps, will have to go on treatment with numbers that are much softer than yours.  You have a 12,000 white count.  They might go on treatment at 8,000 because of some other consequences that are happening to them, at that time.  There are others who may not get treatment when they’re 200,000 or 250,000, because, again, it’s treatment that is chosen for you, at this point in time.  Do you have an anemia?  Do you have difficulty with platelets?  Is there a problem with infections?  What is uniquely happening to you?  That’s what makes the decision for physicians, not numbers. 

So, I know what that does, it leaves you somewhat at sea, because everybody wants to have a little control in life.  Everybody wants to know, when something is going to happen, so that they can prepare for it.  The good news is that will happen when it happens.  The bad news is that will happen when it happens.  There won’t be any signals that say to you, oh, you’re at a 12,000 white count now.  When you hit 35,000 something is going to happen, because nothing might happen.  And, so, the decision is made at the time based on, not just one number, or even two or three or four numbers, but on the whole patient, how they’re feeling, how nervous they are, how unwilling to do treatment they are. 

So, I’d like people to send me more of their comments on this, in more detail, because, maybe, I can help you if I have more information, but there’s also the possibility I’m going to say you’re going to have to talk to your doctor on this one, because he or she is the only one who knows magic to that answer.  So, probably not as successful a segment as others, although I hope it gave you some information. 

This is Susan Leclair thanking you.  If you have questions, and particularly if you want to send me more information, send it to comments@patientpower.info. 

Andrew Schorr:

Thank you for joining us.  Dr. Susan Leclair will be back with more important information for you, the patient, as we continue our series with her.  We’re delighted to have her as a Patient Power contributor. 

I’m Andrew Schorr.  Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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