Many patients require no initial therapy.
Chlorambucil start 5 mg daily x 7 days initially. If tolerated, escalate to 10 mg x 7 days, and if necessary extend duration to 10 and then 14 days, with successive cycles. Repeat cycles every 4-6 weeks, as necessary. Precautions for tumour-lysis should be taken in patients with bulky disease. Hydroxyurea Commence on allopurinol 300 mg daily before hydroxyurea.