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CLL explained: a cancer that often needs no treatment | CION Cancer Clinics
CLL, or chronic lymphocytic leukaemia, is a slow-growing cancer of the white blood cells called lymphocytes. Many people with CLL feel well, are diagnosed from a routine blood test, and do not need treatment for years. Some never need it. This page explains what CLL is, how it is confirmed, what the words on your report mean, and what it cannot tell you about your own case. At CION Cancer Clinics, every leukaemia, MDS and MPN case is reviewed by our haematologist and discussed at a tumour board before a plan is agreed.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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The short answer
What is CLL, in plain words?
Chronic lymphocytic leukaemia (CLL) is a slow-growing blood cancer of the lymphocytes, a type of white blood cell that normally fights infection. Many people with CLL live for years without needing any treatment at all, and some never need it.
What goes wrong inside the body
Your bone marrow makes blood cells. In CLL, one kind of lymphocyte, called a B cell, starts making copies of itself that do not mature properly and do not die off when they should. These cells slowly build up in the blood, the bone marrow, the lymph nodes (the small glands in the neck, armpits and groin) and sometimes the spleen.
Why "chronic" matters so much
Chronic means it develops over a long time. This is very different from acute leukaemia, which moves fast and needs treatment within days. Hearing the word leukaemia is frightening. For most people with CLL, the first news is that nothing needs to be done yet.
Who usually gets it
CLL is mainly a disease of older adults. It is rare in young people and very rare in children. It is slightly more common in men. Having a close relative with CLL raises the chance a little, but most people with CLL have no family history of it.
CLL is not caused by something you ate, a habit, or stress. Nothing you did brought it on.How it shows up
How do people find out they have CLL?
Most people feel completely well. The first sign is often a number on a blood report done for some other reason.
A routine blood test
A complete blood count before surgery, for diabetes or at a health check shows a high white count, with lymphocytes making up most of it. The doctor then asks for more tests.
Swollen glands
Some people notice lumps in the neck, armpit or groin that do not hurt and do not go away after a few weeks. These are enlarged lymph nodes.
Symptoms that build slowly
Less often, the first signs are general ones that creep up over months.
These can include
- Tiredness that rest does not fix
- Drenching night sweats
- Weight loss without trying
- Infections that keep coming back
A full feeling in the tummy
An enlarged spleen sits under the left ribs. It can make you feel full after a small meal or give a dull ache on that side.
Every one of these has many causes other than CLL. A list of symptoms is not a diagnosis.Not sure whether this applies to you?
Ask an oncologistConfirming it
Which tests confirm CLL?
Repeat blood count and smear
The count is checked again, and a doctor looks at the blood under a microscope. CLL cells often look small and fragile, and some break when the slide is made, leaving "smudge cells" on the report.
Flow cytometry
This is the key test. It reads markers on the surface of the lymphocytes and shows whether they all come from one family of cells, with the pattern that fits CLL. It is done on an ordinary blood sample.
Examination and scans if needed
Your haematologist feels for lymph nodes, the spleen and the liver. Scans are not needed for everyone and are usually kept for people with symptoms or planned treatment.
Gene tests before treatment
Tests such as IGHV and TP53 help choose treatment. They are usually done when treatment is being planned, not always on the first day.
On your report
What do the words on a CLL report mean?
- Lymphocytosis
- More lymphocytes in the blood than the laboratory expects. It has many causes, including viral infections, and on its own it is not a diagnosis.
- Monoclonal B cells
- B cells that are all copies of one original cell. This is what flow cytometry looks for.
- CD5 and CD23
- Markers on the cell surface. Seen together on B cells, they fit the usual pattern of CLL.
- SLL (small lymphocytic lymphoma)
- The same disease as CLL, but mainly in the lymph nodes rather than the blood. It is treated the same way.
- MBL
- Monoclonal B-cell lymphocytosis: a small number of CLL-type cells without enough to be called CLL. Most people with MBL never develop CLL.
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Commonly believed
What do families often get wrong about CLL?
"Leukaemia means treatment must start right away."
That is true of acute leukaemia, not CLL. In early CLL, starting treatment before it is needed has not been shown to help people live longer, and it brings side effects for no gain. Waiting is a deliberate plan.
"A white count this high must be dangerous."
In CLL, the size of the white count on its own is rarely the reason to treat. Doctors look at how fast it is rising, whether the red cells and platelets are falling, and how you feel.
"If he is not being treated, the doctor has given up."
It is the opposite. Regular check-ups are the treatment plan at this stage. The doctor is watching for the specific signs that mean treatment would help.
"We should try herbal remedies or a special diet while we wait."
No diet or remedy has been shown to slow CLL. Some herbal products affect the liver or interact with later treatment. Tell your haematologist about anything you take.
Side by side
How is CLL different from acute leukaemia?
CLL
Acute leukaemia
Grows slowly, often over years
Grows fast, over days to weeks
Often found by chance in someone who feels well
Usually makes the person unwell quickly
Many people start with regular check-ups only
Treatment usually starts straight away
Cells look mature under the microscope
Very young cells, called blasts, fill the marrow
Mostly affects older adults
Can affect any age, including children
Being straight with you
What can this page not tell you about your own CLL?
This page cannot tell you how your CLL will behave. Two people with the same white count can have very different courses. Your own outlook depends on the stage, how quickly the counts change, gene test results, your age and your other health conditions.
Why infections matter more than the count
CLL weakens the immune system even before treatment. The lymphocytes are high in number but do not work well, and the body often makes fewer protective antibodies. Chest infections, shingles and skin infections can be more serious than usual. Ask your haematologist which vaccines suit you, and never ignore a fever.
What to bring to your first appointment
Bring every blood report you have, in date order, including old ones done for other reasons. A count from years ago can show how slowly things have changed, which tells the doctor a lot. Bring a list of your medicines and a family member who can take notes.
CION's haematology team reviews the reports, discusses the case at a tumour board and, where a test is not done on site, helps you reach a qualified centre for it.Questions we are asked
Common questions about CLL
Is CLL a real cancer if it does not need treatment?
Yes. CLL is a cancer of the blood and lymph nodes, and it is taken seriously. But it often grows so slowly that treatment gives no benefit until it starts causing problems. Many people find this confusing at first. Regular monitoring is the plan, and it is a proper medical plan.
Can CLL go away on its own?
It does not usually disappear without treatment. What happens more often is that it stays stable for a long time, with counts that barely change between visits. Some people have CLL all their lives and die of something unrelated. Your haematologist will track the trend rather than any single result.
Is CLL passed on to my children?
CLL is not passed on the way some inherited conditions are. Close relatives have a slightly higher chance of developing it, but the chance for any one person stays low. There is no routine screening test recommended for family members who feel well. Mention the family history to your own doctor.
Do I need a bone marrow biopsy?
Often not. CLL can usually be diagnosed from a blood sample using flow cytometry. A bone marrow biopsy, where a small sample is taken from the hip bone, may be advised if the counts are unclear, if red cells or platelets are falling, or before some treatments.
Is CLL the same as lymphoma?
They are closely related. CLL and small lymphocytic lymphoma are the same disease seen in different places: mostly in the blood for CLL, mostly in the lymph nodes for SLL. Both belong to the wider family of lymphomas and are treated in the same way.
Can I work, travel and live normally?
Most people on monitoring carry on with work, family life and travel. The main extra care is around infection: keep vaccines up to date as advised, wash hands well, and see a doctor early with a fever. Tell any new doctor that you have CLL.
What kind of doctor should I see?
A haematologist, a doctor who specialises in blood disorders and blood cancers. At CION, Dr. Basudev Pokhrel and the haematology team review CLL reports and plan follow-up. If your family doctor found the high count, ask for a referral and bring all your reports.
Will I definitely need chemotherapy one day?
Not necessarily. Some people never need treatment. When treatment is needed, many people today receive targeted tablets or antibody treatments rather than traditional chemotherapy. The choice depends on gene test results, your other health conditions and your own preferences, and is discussed with you when the time comes.
Your Haematologist
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- National Cancer Institute — Chronic Lymphocytic Leukemia Treatment (PDQ) - Patient Version
- Cancer Research UK — Chronic lymphocytic leukaemia (CLL)
- NHS — Chronic lymphocytic leukaemia
- Leukaemia & Lymphoma Society — Chronic lymphocytic leukemia
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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