iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL
- Study type
- Clinical guideline
- Study name
- iwCLL 2018
- Design
- Consensus guideline of the International Workshop on CLL (iwCLL) panel, based on evidence and expert opinion
- Source
- Blood · 2018
In plain words
Many people with CLL do not need treatment for years and are only followed with regular tests ("active monitoring"). The iwCLL guideline sets out when treatment is really needed: for example, when anaemia or a low platelet count develops, when the lymph nodes or spleen become very large or cause symptoms, when the lymphocyte count rises very quickly, or when symptoms such as weight loss, fever or night sweats appear. Starting treatment earlier than this does not help people live longer.
Key guideline recommendations
- iwCLL consensus
Definition of CLL: at least 5 × 109/L clonal B lymphocytes in the peripheral blood; if the count is lower and there is lymphadenopathy or splenomegaly, small lymphocytic lymphoma (SLL) is the diagnosis to consider.
- iwCLL consensus
Indication for treatment — progressive marrow failure: development or worsening of anaemia and/or thrombocytopenia; haemoglobin below 100 g/L or platelets below 100 × 109/L is usually an indication for treatment (stable platelets below 100 do not necessarily require treatment).
- iwCLL consensus
Indication for treatment — lymph nodes and spleen: massive lymph nodes (longest diameter more than 10 cm) or progressive or symptomatic lymphadenopathy; massive spleen (more than 6 cm below the left costal margin) or progressive or symptomatic splenomegaly.
- iwCLL consensus
Indication for treatment — progressive lymphocytosis: an increase of more than 50% over 2 months or a lymphocyte doubling time of less than 6 months (after excluding other causes such as infection or corticosteroid use).
- iwCLL consensus
Other indications: autoimmune anaemia or thrombocytopenia poorly responsive to corticosteroids; symptomatic or functional extranodal involvement (e.g. skin, kidney, lung, spine); disease-related symptoms: unintentional weight loss of more than 10% within 6 months, significant fatigue (ECOG 2 or worse), fever above 38°C for 2 weeks or more without infection, or night sweats for more than one month without infection.
Study population
Patients with chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL); covering the definition of the disease, criteria for starting treatment, response criteria, minimal residual disease (MRD) and infection prevention.
Clinical significance and place in guidelines
The iwCLL 2018 criteria for starting treatment and assessing response remain the global reference in clinical practice and trials. The EHA 2026 CLL guideline explicitly reproduces these criteria and recommends starting treatment only when the iwCLL criteria are met (level of evidence I, grade A).
Limitations
The guideline was published before the approval of the newer fixed-duration regimens and of second-generation and non-covalent BTK inhibitors, and its treatment recommendations are outdated; for treatment selection, see the EHA 2026 guideline. The full text was not available for this summary; the criteria for starting treatment and the definition of CLL were verified against their reproduction in the open-access EHA 2026 guideline.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.