Is a very rapidly rising WBC count ever an indication for the upfront treatment of CLL?

This situation, fortunately, does not arise frequently in CLL. But, when it does occur, it is a vexing question. According to the recommendations and guidelines of iwCLL, in absolute terms, the answer (to this question which is worded very carefully) is "NO". But, in my view, there is room for some equivocation.

There are a few key words in the question, which must be kept in mind. These words are "there are no other indications" (for treatment). Thus, we are asked

Is a very rapidly rising WBC count ever an indication for the upfront treatment of CLL?

We have to be very mindful of the 'baseline 'WBC. If the starting WBC is high, 50,000, for example, and it doubles very rapidly, in 6 months, for example and becomes 100,000. If that again ve...