How do you approach small lymphocytic lymphoma that does not have a leukemic phase?

Patients with SLL very often (90-95%) have circulating tumor cells in the blood that are CD19, CD20, CD5, CD23, sig dim by flow consistent with CLL tumor cells. If not in the blood, these same cells evevn more often can be found in the bone marrow. If disease is in either site with nodal involvement...