Chronic Lymphocytic Leukemia (CLL) Treatment

Chronic lymphocytic leukemia (CLL) is generally a slow-growing cancer of the blood and bone marrow. It is one of the most common types of leukemia in adults. Some people with CLL may not need treatment when they are first diagnosed.¹

Treatment for CLL is based on several factors, including:¹

• The stage of CLL
• Whether you have symptoms
• Your age and general health

Types of treatment for CLL

Several different types of treatment may be used for CLL, including:²

• Watchful waiting
• Chemotherapy
• Radiation therapy
• Surgery
• Targeted therapy
• Immunotherapy

Watchful waiting

Doctors may recommend watchful waiting if you do not have symptoms of CLL. During watchful waiting, you do not receive treatment for CLL. However, doctors will treat infections and other health problems.²

Your health is closely monitored during watchful waiting. Your doctor will watch for any changes in your condition and the appearance of symptoms. These may include fatigue, weight loss, fever, drenching night sweats, or an enlarged spleen.²

Chemotherapy

Chemotherapy uses certain drugs to stop cancer cells from growing or reproducing. Chemotherapy works by targeting fast-growing cells, such as cancer cells. However, other fast-growing cells in the body can also be affected. These may include healthy cells in the gastrointestinal tract and hair.^2,3

Chemotherapy drugs may be used with other drugs or alone. They may be taken by mouth or injected into a vein or muscle.^2,3

Radiation therapy

Radiation therapy uses high-energy radiation to kill cancer cells. It may be used when CLL has caused an enlarged spleen. It may also be used to treat bone pain from the growth of leukemia cells in the bone marrow. In some cases, radiation therapy is given to the entire body to prepare for a stem cell transplant.^2,4

Surgery

In some cases, people with CLL may have surgery to remove an enlarged spleen. This surgery is called a splenectomy. While this surgery does not cure CLL, it can relieve some of the symptoms. It can help if an enlarged spleen presses on other organs, like the stomach.^2,5

Targeted therapy

Targeted therapies are cancer treatments that block or kill cancer cells. They interfere with specific parts of cancer cells involved in cell growth or focus on features unique to cancer cells. This can block or slow cancer growth while limiting the impact to healthy cells.²

Types of targeted therapy used to treat CLL include:²

• Monoclonal antibodies, which attach to specific targets to kill cancer cells
• Tyrosine kinase inhibitors (TKIs), which block enzymes that cause stem cells to develop into more white blood cells
• BCL2 inhibitors, which block a protein found on certain leukemia cells

Immunotherapy

Immunotherapy uses your own immune system to kill cancer cells. It may be considered a type of targeted therapy in some circumstances. Immunotherapies used to treat CLL include:^2,6

• Chimeric antigen receptor (CAR) T-cell therapy
• Immunomodulating agents

CAR T-cell therapies, such as Breyanzi®, are newer treatments for CLL. They involve removing your T cells, changing them so they will attach to cancer cells, and returning them to your blood. CAR T-cell therapy with lisocabtagene maraleucel (Breyanzi®) is used for adults with certain forms of CLL that has come back (relapsed) or is not responding to treatment (refractory), and may be used to treat other forms of blood cancer as well.^2,7

Immunomodulating agents are approved for other types of blood cancers. They are not yet approved to treat CLL, but research suggests that they may have benefits. For example, lenalidomide may be used to treat people with certain forms of CLL.^2,8

Other possible treatments for CLL

Some people with CLL may receive treatment with leukapheresis or a stem cell transplant.^9,10

During leukapheresis, the blood is filtered through a special machine. The machine removes a portion of white blood cells, including normal and leukemia cells. It then returns the blood to the person with CLL. Leukapheresis can help if high numbers of leukemia cells are overwhelming normal blood cells.⁹

Stem cell transplants are used with high doses of chemotherapy. The high doses destroy cancer cells. However, they can also damage healthy blood cells. Transplanting stem cells (immature cells that can become new blood cells) can restore the healthy bone marrow.¹⁰

Some clinical trials are testing the benefits of stem cell transplants for people with CLL. Not everyone is a candidate for stem cell transplants. High doses of chemotherapy can be very taxing on your body, so older adults or people with other health problems may not be able to tolerate this treatment.¹⁰

Clinical trials

Clinical trials are a type of research that studies new treatments. Clinical trials investigate the safety and effectiveness of new medicines or procedures. They offer people a chance to receive the latest treatments and be closely monitored by doctors.^2,11

You can learn more about clinical trials by talking to your doctor or visiting the ClinicalTrials.gov website. Your doctor can help you decide whether a clinical trial may be right for you.¹¹