Speaking from the British Society for Haematology (BSH) 2018 Annual Scientific Meeting, held in Liverpool, UK, Niamh Appleby, MB, BAO, BCh, MRCPI, FRCPath, from the University of Oxford, Oxford, UK, discusses key challenges in the treatment of chronic lymphocytic leukemia (CLL), as well as prospects for advancements in treatment. Progression of CLL can vary greatly; however, new genetic techniques, such as whole genome sequencing and targeted deep sequencing, have great potential for identifying how early stage disease might progress, allowing more targeted treatment.