<prompt> Which of the following is true about treatment of CLL?Should be offered to all patientsCan be withheld in asymptomatic patientsIs curativeCombination chemotherapy should be given in patients above 50 years of age  <response>: Ans. b. Can be withheld in asymptomatic patients Ref: Devita 9e p1977-1984: Harrison 19e p701, 18e p927-928Chronic Lymphocytic Leukemia:Treatment is not curativeTreatment not required in asymptomatic patientsTreatment is given to normalize the cell countIn patients less than 50 years, multiple drug therapy is preferredTreatment and Response Criteria in CLLAn unusual feature of CLL compared to other leukemias is that making the diagnosis is not necessarily an indication to initiate treatment. This is true for several reasons.CLL is a disease of the older populationMay be diagnosed in an asymptomatic patientProlonged courseNot curable with current treatment approachesSurvival advantage was not demonstrated with early intervention clinical trials.Allogeneic bone marrow transplantation has not been a viable option in CLL in the past because of the prohibitive toxicity of this approach in a population of older patients.Multiple drug therapy Fludarabine and Chlorambucil is preferred in elderly patients.Indications to initiate treatment for CLLConstitutional symptoms attributable to CLL:weight loss greater than 10 of baseline weight within the preceding 6 monthsextreme fatigue, Eastern Cooperative Oncology Group performance status of 2 or greaterfever temperature greater than 38??C or 100.5??F for at least 2 weeksnight sweats without evidence of infection:Evidence of progressive bone marrow failure characterized by the development or worsening of anemia or thrombocytopenia, or bothAIHA or autoimmune thrombocytopenia, or both, poorly responsive to corticosteroid therapy:Massive greater than 6 cm below the left costal margin or progressive splenomegaly:Massive greater than 10 cm in longest diameter or progressive lymphadenopathyProgressive lymphocytosis defined as an increase in the absolute lymphocyte count by greater than 50 over a 2-month period, or a doubling time predicted to be less than 6 months.LeukemiaTreatmentAMLCytarabine Anthracycline - EtoposideCMLImatinib mesylate DOC, Hydroxyurea, Interferon-yALLInduction: Vincristine, prednisone. Daunorubicin, asparaginase, intrathecal Methotrexate Consolidation: Cyclophosphamide, aspraginase Maintenance: 6-mercaptopurine, MethotrexateCLLFludarabine and Chlorambucil 