<unk>  treatment focuses on controlling the disease and its symptoms rather than on an outright cure. In those without or only minimal symptoms watchful waiting is generally appropriate.<unk>  is treated by chemotherapy, radiation therapy, biological therapy, or bone marrow transplantation. Symptoms are sometimes treated surgically (splenectomy – removal of enlarged spleen) or by radiation therapy ("de-bulking" swollen lymph nodes). Initial<unk>  treatments vary depending on the exact diagnosis and the progression of the disease, and even with the preference and experience of the health care practitioner. Any of dozens of agents may be used for<unk>  therapy. Decision to treat While it is generally considered incurable,<unk>  progresses slowly in most cases. Many people with<unk>  lead normal and active lives for many years—in some cases for decades. Because of its slow onset, asymptomatic early-stage<unk>  (Rai 0, Binet A) is, in general, not treated since it is believed that early-stage<unk>  intervention does not improve survival time or quality of life. Instead, the condition is monitored over time to detect any change in the disease pattern. The decision to start<unk>  treatment is taken when there is evidence for progressive symptomatic disease (summarized as "active disease"). Clinical "staging systems" such as the Rai four-stage system and the Binet classification can help to determine when and how to treat the patient. Determining when to start treatment and by what means is often difficult; no survival advantage is seen in treating people with asymptomatic early-stage<unk> . The International Workshop on<unk>  (iwCLL) has issued guidelines with specific markers that should be met to initiate treatment. Chemotherapy Combination chemotherapy regimens are effective in both newly diagnosed and relapsed<unk> . Combinations of fludarabine with alkylating agents (cyclophosphamide) produce higher response rates and longer progression-free survival than single agents: * FC (fludarabine with cyclophosphamide) * FR (fludarabine with rituximab) * FCR (fludarabine, cyclophosphamide, and rituximab) * CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) Although the purine analogue fludarabine was shown to give superior response rates to chlorambucil as primary therapy, no evidence shows early use of fludarabine improves overall survival, and some clinicians prefer to reserve fludarabine for relapsed disease. Chemoimmunotherapy with FCR has shown to improve response rates, progression-free survival, and overall survival in a large randomized trial in<unk>  patients selected for good physical fitness. This has been the first clinical trial demonstrating that the choice of a first-line therapy can improve the overall survival of people with<unk> . Alkylating agents approved for<unk>  include bendamustine and cyclophosphamide. Targeted therapy Targeted therapy attacks cancer cells at a specific target, with the aim of not harming normal cells. Targeted drugs used in<unk>  include venetoclax (a Bcl-2 inhibitor), ibrutinib (a Bruton's tyrosine kinase inhibitor), idelalisib and duvelisib (inhibitors of some forms of the enzyme phosphoinositide 3-kinase), as well as monoclonal antibodies against CD20 (rituximab, ofatumumab and obinutuzumab) and CD52 (alemtuzumab). Stem cell transplantation Autologous stem cell transplantation, using the recipient's own cells, is not curative. Younger individuals, if at high risk for dying from<unk> , may consider allogeneic hematopoietic stem cell transplantation (HSCT). Myeloablative (bone marrow killing) forms of allogeneic stem cell transplantation, a high-risk treatment using blood cells from a healthy donor, may be curative, but treatment-related toxicity is significant. An intermediate level, called reduced-intensity conditioning allogeneic stem cell transplantation, may be better tolerated by older or frail patients. Refractory<unk>  "Refractory"<unk>  is a disease that no longer responds favorably to treatment within 6 months following the last cancer therapy. In this case, more aggressive targeted therapies, such as BCR or BCL2 pathway inhibitors, have been associated with increased survival. During pregnancy Leukemia is rarely associated with pregnancy, affecting only about one in 10,000 pregnant women. Treatment for<unk> s can often be postponed until after the end of the pregnancy. If treatment is necessary, then giving chemotherapy during the second or third trimesters is less likely to result in pregnancy loss or birth defects than treatment during the first trimester.
Chronic lymphocytic leukemia
Hairy cell leukemia
Chronic neutrophilic leukemia
Infectious mononucleosis
AIDS-related lymphoma
Acute lymphoblastic leukemia
Prolymphocytic leukemia
Persistent polyclonal B-cell lymphocytosis