Factors Affecting Time to First Treatment in Early-Stage Chronic Lymphocytic Leukemia: A Single-Center Retrospective Cohort Study

Background/Objectives: Most patients with chronic lymphocytic leukemia (CLL) are diagnosed at an early stage, but the time to first treatment (TTFT) varies widely. We aimed to identify clinical and routine laboratory factors associated with TTFT. Methods: We retrospectively analyzed 103 patients with Rai stage I–II CLL followed at a tertiary center between 2005 and 2025. TTFT was the primary endpoint, and overall survival (OS) the secondary endpoint; Kaplan–Meier, competing-risk, and Cox regression analyses were performed. Results: Median age was 71 years; 78 patients (75.7%) had Binet stage B disease. During a median follow-up of 125.8 months, 66 patients (64.1%) received treatment (median TTFT, 38.1 months). Only 1 of 25 Binet stage A patients required treatment, versus 65 of 78 Binet stage B patients (median TTFT, 20.2 months; p < 0.001). In multivariable analysis, Binet stage B (hazard ratio [HR] 34.8, 95% confidence interval [CI] 4.8–252.4) and a higher absolute lymphocyte count (ALC; HR 1.33 per doubling, 95% CI 1.10–1.61) were independently associated with a shorter TTFT, whereas age, sex, lactate dehydrogenase, and β2-microglobulin were not. The neutrophil-to-lymphocyte ratio added no information beyond ALC. No factor was independently associated with OS. Conclusions: In this tertiary referral cohort of Rai stage I–II CLL without Rai stage 0 patients, Binet stage and lymphocyte count, available from a physical examination and a complete blood count, identified patients likely to need treatment soon and may guide follow-up when molecular markers are unavailable. These findings should not be extrapolated to all patients with asymptomatic early-stage CLL.