Problem: The National Comprehensive Cancer Network (NCCN) recommends a structured, molecular-guided approach to CLL management that begins with determining whether treatment is indicated, followed by risk stratification based on del(17p)/TP53 mutation status and IGHV mutation status to select optimal therapy. [1] Indications for Treatment Not all CLL patients require treatment at diagnosis. The NCCN algorithm specifies that treatment should be initiated only when one or more of the following are present: [1] Significant disease-related symptoms (severe fatigue, drenching night sweats, unintentional weight loss ≥10% in 6 months, fever without infection) Threatened end-organ function Progressive, symptomatic, or bulky disease (spleen >6 cm below costal margin, lymph nodes >10 cm) Progressive thrombocytopenia or anemia Steroid-refractory autoimmune cytopenias Absolute lymphocyte count alone is not an indication for treatment in the absence of leukostasis. [1] Patients without treatment indications should be observed; CT scans are not required for routine monitoring outside of clinical trials. [1] Pre-Treatment Evaluation Prior to initiating therapy, the following must be assessed: [1] FISH for del(17p) TP53 mutation status CpG-stimulated metaphase karyotype (for complex karyotype) IGHV mutation status Imaging as appropriate; bone marrow aspirate and biopsy as clinically indicated make into a concise paragraph. Need Assignment Help?