Watch and wait

For many, it's hard to understand why you would wait to treat cancer. In the above video, CLL experts, Dr. Michael Keating and Dr. Januario Castro, explain why it's necessary and beneficial to watch and wait with CLL. Dr. Castro shares the reasoning behind waiting to treat the condition, including lack of symptoms as well as side effects and toxicities. Dr. Keating explains how CLL is different from other cancers in that it's important to study the behaviour (watch) of this particular disease in order to decide the best treatment approach and when to begin treatment. With the ever-evolving landscape of treatment for CLL, new and better options are becoming available over time, which is another benefit of watch and wait.


Why do doctors not recommend treatment for CLL straight away?

It seems odd. One would expect that treating CLL at the earliest stages would lead to a better outcome but often doctors recommend a “Watch and wait” approach or as many patients and their carers perceive it – “Do nothing”!!!

Currently there is no evidence that treating patients found by chance (about 65% of those found) or those with asymptomatic stable disease leads to a better outcome in the long term. There will be symtoms from the CLL if it progresses. Just as there will be some side effects from treatment.  So the right approach for the majority of patients at diagnosis - is to “Watch and Wait”.  

Watch and Wait will involve regular blood checks and examinations until treatment is required. The frequency of these checks will depend on the stage of the CLL. On diagnosis checks will be more frequent to see how the CLL develops. If there is little change then the frequency could be every 6 or 12 months. If thing develop and treatment become nearer the frequency of checks will increase.  

Treatment for CLL should only be initiated when the CLL patient stands to benefit. A rising lymphocyte counts can be of concern to patients but unless it is accompanied by symptoms like enlarged lymph node, liver or spleen, falling haemoglobin or platelet count it is unlikely that you need immediate treatment.  A rising lymphocyte count may be a reason for re-assessment of your disease or closer monitoring of it.

A Practical Guide for Newly Diagnosed CLL Patients and those close to them. Read more: A Practical Guide for Newly Diagnosed CLL Patients and those close to them.


Bloodwise information booklet:



Leukaemia Care information booklet


Step by Step on Watch & Wait is a very helpful website with a good watch and wait section where CLL patients share their watch and wait experiences in videos with transcripts.


Visit the CLL Support Association on-line community watch and wait discussions


For more in depth and extensive reading, try Dr Sharman's blog:

Watch and Wait (AKA: Watch and Freak Out)


When to treat CLL