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Treatment may be necessary only if the level of abnormal white blood cells, or B lymphocytes, rises high enough to cause symptoms. Those symptoms can include fatigue, weakness, and shortness of breath caused by a low number of red blood cells, a condition called anemia. Infections stemming from low levels of healthy white blood cells or bleeding caused by too few platelets, the blood cells that stop bleeding, may also indicate the need for treatment.

Your doctor may monitor swelling in the abdomen caused by an enlarged spleen or liver, organs that filter the blood. Abnormal B lymphocytes can collect in the organs, causing them to swell. Sometimes B lymphocytes also collect in the lymph nodes—small immune system glands that trap bacteria and viruses—causing them to swell.

During watchful waiting, your doctor can conduct tests to check your blood cell counts and measure the number of abnormal B lymphocytes in the blood. He or she may also perform imaging tests, such as a CT scan or ultrasound, if there’s a suspicion that the spleen or liver is enlarged. These imaging tests may also locate swollen lymph nodes.

During this time, your doctor may recommend checkups as often as every three to six months or whatever interval is right for you. A small number of people who undergo watchful waiting never experience symptoms and do not need treatment. Some remain symptom-free for several years or even decades before requiring therapy.

If your doctor notices that hairy cell leukemia may be progressing, he or she can discuss treatment options with you.