Diagnosis and staging
CLL is confirmed by a persistent lymphocytosis with a characteristic immunophenotype on flow cytometry. The blood film, cell counts and clinical examination provide staging information.
FISH for deletions and TP53 status, IGHV mutation status and other markers help define prognosis and guide treatment selection. Not every patient needs every test at diagnosis, but the results matter before starting therapy.
Related: Haematology → · Dr. Sachita Baniya profile → · All conditions →
When treatment starts
Not all CLL requires immediate treatment. Observation is appropriate for many patients with stable counts and no symptoms. Treatment is considered when there are progressive cytopenias, bulky or symptomatic lymphadenopathy or splenomegaly, constitutional symptoms, or rapid disease progression.
The decision is based on symptoms, blood counts, disease biology and the patient's age, fitness and preferences — not on the lymphocyte count alone.
- Progressive anaemia or thrombocytopenia
- Bulky or symptomatic lymph nodes or spleen
- Night sweats, weight loss or unexplained fever
- Rapidly rising lymphocyte count or worsening symptoms
Treatment options
Modern CLL treatment is often targeted: BTK inhibitors, BCL-2 inhibitors such as venetoclax, and combinations are used according to the disease profile and patient factors. Chemoimmunotherapy still has a role in selected cases.
Relapsed or high-risk disease may need a different targeted combination, a clinical trial, or assessment for allogeneic transplant or cellular therapy in selected patients. Supportive care includes infection prevention and vaccination review.
Access and booking
Dr. Baniya consults at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, and also practises at Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital, Kathmandu, and Advanced Care Hospital. Appointments are arranged at the Durbar Marg clinic or through the respective hospital or cancer centre. Bring all blood counts, marrow, flow cytometry and molecular reports.