Chronic lymphocytic leukemia (CLL) is a type of cancer in which the bone marrow produces too many white blood cells called lymphocytes. It typically progresses slowly. Most people only begin treatment once they start to experience bothersome symptoms.

Chronic lymphocytic leukemia (CLL) typically progresses slowly. Most people only begin treatment once they start to experience bothersome symptoms. While treatments typically cannot cure CLL, they can offer symptom relief and improve a person’s quality of life.

This article explores the first- and second-line treatment approaches for CLL as well as supportive care options.

A person with CLL and a headscarf awaits treatmentShare on Pinterest
Design by MNT; Photography by Drazen_/Getty Images & Dr Graham Beards, CC BY-SA 3.0, via Wikimedia Commons

CLL is a slow progressing cancer. People can live a long time with the disease.

The American Cancer Society notes that CLL is difficult to cure, and that doctors typically recommend delaying treatment until the disease is progressing. This is because early treatment does not usually extend survival times, and the treatments themselves can cause side effects.

Below are some potential treatment options for people with CLL.


People with CLL may receive chemotherapy drugs, which stop or slow the growth of cancer cells. People may take the drugs orally or intravenously.

Chemotherapy drugs that doctors may use as first-line treatment for CLL include:

Chemotherapy drugs indiscriminately attack any fast-dividing cell, regardless of whether the cell is cancerous or not. According to the National Cancer Institute, this is why a person can develop chemotherapy side effects, such as:

Learn more about chemotherapy.

Monoclonal antibodies

Monoclonal antibodies (MABs) are lab-made proteins that function similarly to human antibodies in the immune system.

According to Cancer Research UK, there are different types of MABs. Depending on the type, a MAB may work by:

  • attaching to proteins on the cancer cell, thereby flagging it to the immune system for destruction
  • blocking proteins that are preventing the immune system from destroying the cancer cell
  • blocking signals that instruct the cancer cell to divide
  • carrying drugs or radioactive substances to the cancer cell to aid its destruction

Examples of MABs include:

  • Rituximab: A person may receive rituximab with a chemotherapy drug or as a second-line treatment.
  • Obinutuzumab: A person may receive this drug plus a chemotherapy drug. A doctor may also prescribe it for CLL that returns following treatment, or for CLL that does not respond to other treatments.
  • Ofatumumab: Doctors may prescribe ofatumumab if a person’s cancer is not responding to other types of treatment.

People who receive MABs intravenously may develop side effects such as:

Targeted therapy

Targeted therapy drugs work on the changes inside cells that cause them to turn into cancer.

For example, ibrutinib is one targeted therapy drug that medical professionals use as a first-line treatment for CLL. This drug blocks proteins called Bruton’s tyrosine kinase (BTK) inhibitors, which ordinarily help cancer cells to survive.

Ibrutinib causes mild side effects, including:

Acalabrutinib is another drug that blocks BTK activity. Doctors may recommend it if other treatments have not worked.

If first-line treatments do not improve symptoms, or if the cancer returns, medical professionals may use second-line treatments.

According to the American Cancer Society, the medications a person receives during their second-line treatment will depend on the medications they received during their first-line treatment.

In some cases, the second-line treatment may consist of the same drugs, but a doctor may adjust the dosage or dosing schedule.

In other cases, the second-line treatment may incorporate other drugs or therapies, such as:

  • other chemotherapy drugs
  • a combination of MABs and targeted therapy drugs

People with CLL may need supportive treatments to reduce their risk of developing anemia or recurrent infections.

Below are some supportive treatments a doctor may recommend.

Antibiotics and antiviral drugs

People who receive chemotherapy or antibody drugs have an increased risk of developing pneumonia and a type of herpes virus called cytomegalovirus (CMV).

Doctors may prescribe a sulfa antibiotic to help prevent certain types of pneumonia and antiviral drugs, such as acyclovir or valacyclovir, to help prevent CMV.


Doctors may recommend a person with CLL receive a pneumonia vaccine every 5 years and a flu vaccine every year.

According to Cancer Research UK, people with CLL should avoid vaccines containing live viruses. This is because CLL weakens the immune system, making a person more susceptible to illness from a live virus.

Blood transfusions

People who develop anemia as a result of CLL may require a blood transfusion to boost levels of red blood cells.

Below are some additional treatment options for CLL.

Stem cell transplant

A stem cell transplant involves removing blood-forming stem cells from a donor and implanting them into a recipient to help restore the recipient’s bone marrow.

Before receiving a stem cell transplant, a person undergoes high dose chemotherapy alone or in combination with radiation therapy. This helps destroy as many cancer cells as possible before the person receives the stem cell transplant.

Learn more about stem cell transplants.

Radiation therapy

Radiation therapy uses high energy rays to kill cancer cells. This therapy is not a standard treatment for CLL. However, the Leukemia & Lymphoma Society notes that doctors may recommend radiation therapy for the following:


CLL can cause an enlarged spleen, which puts pressure on nearby organs.

In rare cases, surgeons may remove the spleen in a procedure called splenectomy.

Palliative care is a specialized form of medical care for people with serious or complex illnesses, such as CLL. The goal of palliative care is to help manage a person’s symptoms and improve their quality of life, whatever the stage of their disease.

A person will receive care from a team of doctors, nurses, and support workers. Care can take place in a hospital or outpatient clinic.

People receiving treatment for CLL may need to attend weekly or monthly medical appointments. During these appointments, the person’s medical team will ask about any new cancer symptoms or treatment side effects. Doctors may then adjust treatment plans accordingly.

During these appointments, people can also consider talking about any concerns they have regarding their mental health. Receiving a cancer diagnosis and undergoing cancer treatment can cause a range of emotions, including anxiety or depression.

People undergoing CLL treatment may benefit from the following:

  • talking with supportive family and friends
  • joining a CLL support group
  • receiving individual or group therapy

Chronic lymphocytic leukemia (CLL) is a slow developing cancer of the blood and bone marrow. The disease is typically very difficult to cure, but treatments can help alleviate symptoms that develop as the disease progresses.

Treatments for CLL may consist of chemotherapy, monoclonal antibodies, targeted therapy, or some combination of the three. Supportive therapies may also be necessary. These may include vaccines, blood transfusions, and medications to prevent infections.

A person who is receiving CLL treatment will need to attend regular medical appointments so their care team can check their response to the treatment. During these appointments, a person can also notify their care team of any new side effects and voice any other concerns they may have.