Disclaimer: To protect patient privacy, this question has been edited slightly to omit identifying details.
A Patient Power user with chronic lymphocytic leukemia (CLL) asked: “Is there a threshold for low platelets before treatment?”
Expert Response
“Most guidelines recommend considering treatment for CLL if the CLL is causing the platelet count to be consistently less than 100 (which is 100,000 /uL),” said Kerry Rogers, MD, from The Ohio State University Comprehensive Cancer Center – The James.
“It is also important to show that the low platelets are from the CLL infiltrating the bone marrow, and not some other cause, and this is typically done with a bone marrow biopsy,” Dr. Rogers said. “The threshold of 100 is not mandatory, and most doctors who treat CLL will wait until the platelets are consistently less than 100 and dropping before starting treatment.”
“The good news is we all have way more platelets than we need,” Dr. Rogers added. “It is rare to see bleeding with a platelet count above 20-30. Most bleeding from low platelet occurs when the platelet count is less than 10. Blood thinners (anticoagulants) can be used, and surgery can safely be done at a level of above 50 – just to give you an idea.”
“The goal is to start treatment to improve the platelets before there is a risk of them being less than 10-20,” Dr. Rogers said.
Historically, “the threshold for treatment of platelets less than 100 was chosen at the time where we used chemotherapy, which would further lower the platelet count from the drug,” Dr. Rogers said. “With our newer drugs such as BTKi (like acalabrutinib) and venetoclax, the drug itself decreases platelets less and allows for recovery from the CLL effects faster, so most CLL experts are fine waiting until the platelets are solidly less than 100 or really even around 50-70. It is very situation dependent, since if the platelets are dropping rapidly then it is best to treat sooner.”
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