Answer:  The decision of when to treat is based upon many factors. First, it is important to take into consideration the patient’s symptoms. Is the patient having excessive fatigue, night sweats, or symptoms from an enlarged spleen? For example, discomfort in the left upper part of the abdomen can reflect an enlarged spleen. Is the patient having pain or discomfort over the spleen? Is an enlarged spleen causing the patient to have an excessive “full sensation” after eating?

In addition to symptoms from the hairy cell leukemia, several generalizations can be made about the blood counts. While there is individual variation among hematologists, the trend and the absolute numbers of the blood counts are important in deciding when to treat. Some hematologists say that a decreasing hemoglobin to <11, or absolute neutrophile count consistently trending down below 1,000, or a consistent decline in platelets to <100,000. These trends will also require judgment from the physician on when and how to treat. If the trends go below these “rough estimated parameters” and the patient is prepared for treatment, then it may be wise to not wait until the counts are very low. Furthermore, it would be good to treat before the patient develops an active infection rather than waiting until the patient has an active infection which makes the treatment more challenging. Close discussion with the treating physician is important, and good clinical judgment plays an essential role in successful management.

Posted October 2013 in the category: When to Treat or Re-Treat