Chronic lymphocytic leukemia (CLL) remains an incurable disease, except in rare cases treated with allogeneic stem-cell transplantation or favorable-risk CLL treated with chemoimmunotherapy. Treatment initiation follows the Rai and Binet staging systems, but the International Workshop on Chronic Lymphocytic Leukemia criteria emphasize active disease rather than stage alone. Early treatment in asymptomatic, high-risk patients has not shown an overall survival benefit, even with targeted therapies such as Bruton's tyrosine kinase and BCL2 inhibitors. The watch-and-wait strategy remains standard, although future trials may refine early treatment indications for specific high-risk groups.