Chronic lymphocytic leukemia is an inert hematologic malignancy that predominates in the elderly in Western countries. The median age of onset is around 70 years. In the face of such a relatively inert hematological disease with a high age of onset, how should we deal with it at the time of initial diagnosis and treatment? More importantly, we are now in the era of “chemofree”, so how should we use these weapons well? In my opinion, from diagnosis to treatment, the whole management of slow gonorrhea needs the word “precision”. The diagnosis of CLL is mainly made by the peripheral blood monoclonal B lymphocyte count >5*109 and the typical immunophenotype. The typical phenotypes of CLL are CD5+, CD19+, CD23+, FMC7 negative, and sIg weakly expressed. When a patient meets these two criteria, chronic lymphocytic leukemia can be diagnosed without bone aspiration. However, the diagnosis of chronic lymphocytic leukemia is far from being satisfied with this, and as medicine has entered the so-called era of precision medicine, we must make a more accurate diagnosis. First of all, accurate staging has been used since the publication of Rai staging in 1975 and Binet staging in 1981 in Blood and Cancer journals, and is still guiding clinical practice. These two staging systems reflect mainly the size of the tumor load and the interference with normal hematopoiesis caused by chronic proliferation of lymphocytes. It reflects the main clinical features of slow gonorrhea such as the count of lymphocytes, the number and size of lymph nodes and the presence or absence of enlargement of liver and spleen, especially the clinical consequences of anemia and thrombocytopenia, through data that are very easy to obtain clinically. 2, accurate molecular typing, this is even more important. Studies have shown that molecular typing is very important in the diagnosis of slow gonorrhea, by detecting the presence of TP53 gene and IGHV (immunoglobulin heavy chain variable region) mutations, integrated into the above-mentioned Rai stage and Binet stage, combined with the patient’s age and β2-MG level, forming the CLL-IPI system. For example, the 5-year survival rate in the very high-risk group with a score of 7-10 is only about 23%, while the 5-year survival rate in the low-risk group with a score of 0-1 is over 93%, and it can be expected that this group of patients is capable of long-term survival. Analysis of this table shows that whether TP53 is mutated or not is the main risk factor that affects the prognosis. The prognosis was better for the IGHV mutated type and worse for the unmutated type. Studies have also shown that abnormalities in chromosome 11 also affect the prognosis of CLL and are a marker of poor prognosis in CLL. del(11q) is seen in about 20% of CLL patients; and del(11p) implies poor efficacy for single agent fludarabine and nitrogen mustard phenylbutyrate. Second, the precision of treatment The purpose of precise diagnosis is for precise treatment. Unlike other diseases, even if we target for chronic lymphatic leukemia, we should pay special attention to whether patients have treatment pointers. The IWCLL, including the Chinese version of the Chronic Lymphatic Leukemia Guidelines, emphasizes that treatment for Chronic Lymphatic Leukemia should only be initiated when one of the following indicators is present: 1. Evidence of progressive bone marrow failure, as evidenced by a progressive decrease in hemoglobin, platelets, and/or blood platelets. 2. Giant spleen such as >6 cm below the left costal margin or progressive or symptomatic splenomegaly 3. Giant lymph node enlargement with a maximum diameter of >10 cm or progressive or symptomatic lymph node enlargement 4, Progressive lymphocyte count increase, such as 50% increase within 2 months or lymphocyte doubling time (LDT) < 6 months, when the initial lymphocyte count < 30*109, cannot be used as a treatment guideline based on LDT alone. 5.Lymphocyte count >200*109,or the presence of leukocyte stasis. 6, autoimmune hemolytic anemia or thrombocytopenia when they do not respond well to corticosteroids or other standard treatments; 7, the presence of at least one of the following disease-related symptoms: weight loss ≥ 10% without apparent cause within the previous 6 months; severe fatigue; fever > 38°C for ≥ 2 weeks without evidence of infection, night sweats > 1 month, From these above pointers, it is actually also the A precise assessment before treatment, the purpose of which is to select those slow gonorrhea patients who need treatment for population enrichment, thus helping to meet the clinical needs of patients while avoiding the harm caused by unnecessary treatment! The precision of treatment is also reflected in the precision of drug selection. The first line of choice is a BTK inhibitor, whether young or old, frail or in good general condition, and whether or not combined with TP53 mutations and IGHV mutations. is the BTK inhibitor ibrutinib really a “winner takes all”? If we go back to the clinical reality in China, does a young, low-risk patient need to be on ibrutinib for life? The E1912 study of FCR versus IR showed that the 3-year OS rate in the FCR group was 92%, and importantly, the FCR group was able to meet the patient’s needs for stopping treatment and achieving a “timefreetreat? The goal of “timefreetreat” was achieved. Especially for a chronic disease such as LHC, it is necessary to consider the patient’s actual condition, willingness to treat, and economic status. Therefore, the Chinese version of chronic gonorrhea guideline also recommends FCR as a category to patients, the purpose of which is to exchange the limited treatment course for more treatment-free time and reduce the treatment burden of patients. The deferral of treatment with BTK inhibitors in low-risk patients also reflects the idea of precision therapy. Of course, high-risk patients or elderly and frail patients should choose a BTK inhibitor-based regimen. Third, the precision of efficacy assessment The process of treatment is always to “look back”, this process is to assess the efficacy. It is a scientific process to choose what indexes, what standards need to be achieved, and at what time point to evaluate. In the case of slow gonorrhea, there are two major categories of indicators to be selected, one is the degree of response to the decrease of tumor load, and the other is the degree of recovery from hematopoietic involvement. The efficacy criteria can be divided into four levels: CR, PR, SD and PD, as detailed in the following table: When should we make efficacy evaluation? Current national and international guidelines consistently recommend efficacy evaluation during the treatment of CLL. Induction therapy is usually about 6 cycles, so the guidelines recommend an interim efficacy evaluation at 3-4 cycles, or at least 2 months after the end of chemotherapy or chemoimmunotherapy, to allow the drugs to be fully effective. In conclusion, slow gonorrhea is a special disease and patients with slow gonorrhea are a special group that requires standardized treatment based on adherence to guidelines and evidence. The first step is accurate diagnosis and staging, followed by fine individualized treatment under the guidance of prognostic stratification; dynamic observation and assessment of efficacy, and timely treatment adjustment. This will ensure that patients can avoid adverse drug reactions as much as possible on the basis of maximum benefit.