Treatment for chronic lymphocytic leukemia (CLL) can range from watchful waiting to more aggressive treatments to slow the condition’s progression. CLL has no cure, but effective treatment can help a person live a longer, healthier life.

CLL is the most common leukemia in adults. The condition occurs when a person’s bone marrow produces too many white blood cells.

Over time, the abundance of white blood cells causes other blood counts, such as red blood cells and platelets, to drop. Symptoms tend to develop slowly and do not occur in about 50% to 70% of newly diagnosed cases.

The following article outlines various medical and alternative treatments for CLL, diet tips, and how different factors may affect a person’s treatment.

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People with a CLL diagnosis who are not experiencing symptoms may not yet require treatment.

Instead, a doctor may recommend a watch-and-wait approach.

In the meantime, a person may want to make dietary or lifestyle changes with the approval of their doctor.

Once symptoms start, a doctor may work with the individual to develop a treatment plan that works for them based on current treatment approaches.

Immunotherapy helps strengthen the immune system against leukemia. Typically, doctors administer this medication intravenously in a clinical or medical office setting.

There are several approved medications that target different antibodies in the immune system.

Immunotherapy may cause side effects in some people. Side effects can include:

Chimeric antigen receptor (CAR) T-cell therapy

The Food and Drug Administration (FDA) first approved CAR T-cell therapy in 2017.

CAR T-cell therapy involves removing some of a person’s T cells, modifying them in a lab to attack cancer cells, and then returning them to the person’s blood.

Lisocabtagene maraleucel (Breyanzi) may be used to treat adults with CLL that is still growing, or that returned after remission. Often, doctors recommend it after trying at least two different types of targeted drugs.

CAR T-cell therapy can cause several potentially serious side effects.

Some people may develop cytokine release syndrome (CRS), where immune cells release a large amount of chemicals into the blood. This can cause symptoms such as:

  • headaches
  • difficulty breathing
  • fever
  • diarrhea
  • chills
  • a very fast heart rate
  • nausea and vomiting
  • swelling
  • fatigue or weakness
  • very low blood pressure

CAR T-cell therapy can also cause neurological or nervous system problems. Symptoms can include:

  • changes in consciousness
  • confusion
  • seizures
  • difficulty speaking
  • tremors

Like other immunotherapies, it can also cause issues with the immune system, potentially leading to severe infection. It may also lower blood cell counts.

Learn more about CAR T-cell therapy.

Antibodies that target CD20

Certain immunotherapies target CD20, a protein on the surface of B lymphocytes where CLL starts.

There are several types of CD20 targeting medications, including:

  • Obinutuzumab (Gazyva): Doctors often use this as a second-line treatment if CLL is not responding to other therapies or to alemtuzumab, another type of immunotherapy drug.
  • Rituximab (Rituxan): Doctors may use this as a first- or second-line treatment on its own or along with chemotherapy or targeted therapy. This may also be administered as an injection.
  • Ofatumumab (Arzerra): This is often a first-line therapy alongside chemotherapy or targeted therapy, or used on its own if CLL returns or does not respond to other treatments.

Side effects of CD20 targeting antibodies can occur either during infusion or for several hours following. Mild issues can include:

  • headaches
  • rashes
  • chills
  • nausea
  • fatigue
  • itching
  • fever

More serious side effects can include:

  • heart racing
  • chest pain
  • cough
  • trouble breathing
  • feeling dizzy, lightheaded, or faint
  • swelling of the face and tongue

They can also increase the risk of serious infection. It may also cause a hepatitis B infection if the virus was dormant.

Antibodies that target CD52

CD52 is an antigen found on the surface of CLL cells and many T lymphocytes. Alemtuzumab (Campath) is a medication that targets cells with CD52.

Doctors often use this when other treatments for CLL are no longer working, but doctors may recommend it in some instances as a first-line option.

It is often helpful for people with CLL with a chromosome 17 deletion. In those cases, a doctor may recommend it as a first-line treatment along with rituximab.

Alemtuzumab can cause infusion reactions, including:

  • fever
  • chills
  • flushing of the face
  • difficulty breathing
  • rash
  • itchy skin
  • wheezing
  • feeling dizzy

It can also increase a person’s risk of serious infection due to a reduced immune system response.

Targeted therapy works by only targeting the cancer cells, meaning it causes less damage to healthy cells than treatment methods such as chemoimmunotherapy.

Doctors usually recommend it for people whose cancer has a del(17p)/TP53 mutation. This means it has a type of mutation that responds to targeted therapy. It is often the first line of treatment used when a person needs to treat CLL.

Targeted therapy can usually control CLL well, which means a person may not need some other types of treatment immediately.

A person can take targeted therapy medication in pill form. However, for it to work effectively, a person needs to take the medication exactly as the doctor has prescribed.

There are several different targeted therapies available that target different proteins in cancer cells. Broad types include Bruton’s tyrosine kinase (BTK) inhibitors, BCL-2 inhibitor, and PI3K inhibitors.

Bruton’s tyrosine kinase (BTK) inhibitors

BTK is a type of protein found in CLL cells that helps the cancer survive and grow. These medications target BTK, causing cell death and reduced growth rates in the cancer cells.

Medications that are BTK inhibitors include:

  • acalabrutinib (Calquence)
  • ibrutinib (Imbruvica)
  • pirtobrutinib (Jaypirca)
  • zanubrutinib (Brukinsa)

Common side effects can vary between the specific medications, but can include:

  • increased risk of infection
  • headaches
  • nausea
  • anemia
  • easy bruising
  • fatigue

They may also cause more serious side effects in some people, such as bleeding, increased heart rate, and severe infection.

BCL-2 inhibitor

The BCL-2 protein in CLL cancer cells helps them live for longer periods. These medications work to destroy this protein, helping to destroy the cancer.

Currently, venetoclax (Venclexta) is available as a BCL-2 inhibitor in the United States. It is often used alone or along with an immunotherapy option.

It comes in pill form.

Common side effects can include:

  • anemia
  • respiratory infections
  • nausea
  • low white blood cell counts
  • feeling tired
  • diarrhea
  • low platelet counts

PI3K inhibitors

Phosphatidylinositol 3-kinases (PI3Ks) are proteins that send growth signals within cancer cells. PI3K inhibitors are taken orally as pills.

Doctors often recommend this type of therapy when CLL does not respond well to previous treatments.

There are two types: idelalisib (Zydelig) and duvelisib (Copiktra). They work in similar ways, targeting growth proteins in the cells.

Common side effects include:

  • diarrhea
  • fever
  • nausea
  • pneumonia
  • fatigue
  • cough
  • belly pain
  • rash
  • joint or muscle pain

They may also cause more serious side effects, such as anemia, organ damage, or severe infections.

Chemoimmunotherapy involves using both chemotherapy and immunotherapy to treat CLL. Doctors rarely recommend chemotherapy on its own to treat CLL, but combined with immunotherapy, it can be an effective treatment.

A person may experience side effects of either chemotherapy or immunotherapy during this type of treatment.

Chemotherapy options include purine analogs, alkylating agents, and corticosteroids. Typically, a person receives treatment in a facility through an IV infusion.

Purine analogs include:

  • cladribine (2-CdA, Leustatin)
  • fludarabine (Fludara)
  • pentostatin (Nipent)

Doctors often recommend alkylating agents in conjunction with immunotherapy. Examples include:

  • cyclophosphamide (Cytoxan)
  • chlorambucil (Leukeran)
  • bendamustine (Treanda)

Corticosteroids that doctors may use for CLL include:

  • prednisone
  • dexamethasone
  • methylprednisolone

Chemotherapy is not a targeted therapy, meaning it can cause damage and cell death to more than just cancer cells. This can lead to a range of side effects. Common ones include:

  • low blood counts
  • hair loss
  • loss of appetite
  • mouth sores
  • vomiting
  • nausea

It can also cause fatigue, increased risk of infection, and easy bruising.

In stem cell transplants, a donor provides healthy bone marrow (allogeneic transplant) that will help produce healthy cells. Alternatively, doctors may remove and store stem cells from the same person (autologous transplant) undergoing treatment. The stem cells can then help destroy the cancerous cells and help the body recover from aggressive treatment.

Doctors may recommend stem cell transplants if:

  • the cancer does not respond well to other treatments
  • the cancer is more difficult to treat, such as chromosome 17 deletions and TP53 mutations
  • the cancer returns

Before a stem cell transplant, a person will typically undergo chemotherapy or radiation to destroy cancerous cells and make room for the transplanted cells. A person may experience side effects from radiation, chemotherapy, or from the transplant itself.

Transplants can potentially have several severe side effects. These can include:

  • bleeding issues
  • increased risk of infections
  • vomiting and nausea
  • lung issues, such as pneumonia
  • mouth or throat pain
  • poor host acceptance

Radiation therapy uses high powered X-rays to help kill cancer cells and stop them from spreading. It can help reduce pain associated with swollen lymph nodes and the spleen.

Doctors may also use radiation therapy during stem cell transplants to make room for healthy cells.

Possible side effects of radiation can include:

  • low blood cell counts, which increases infection risk
  • skin changes in the treated area
  • diarrhea
  • fatigue
  • nausea and vomiting

Clinical trials are research studies that look at the effectiveness of new medications or treatments for conditions such as CLL.

Clinical trials have different stages based on where they are in their testing process. In general, the later the stage of the trials, the closer the medication is to being approved for use in the general population.

Not everyone qualifies or would be interested in joining a clinical trial. Those who are can speak with their doctor about any upcoming trials and discuss whether they would be a suitable candidate. They can also search for upcoming trials through ClinicalTrials.gov.

In addition to medical treatments, a person may find that alternative and natural treatments may be helpful. These treatments should not replace medical treatment. Instead, they can be useful in conjunction with medical treatment to help ease symptoms and improve a person’s quality of life.

Before starting an alternate or natural treatment, a person should discuss their plans with their doctor. They can help determine what treatments may work best and help the person avoid negative interactions with their current medications.

Some common alternative and natural treatments for CLL include:

Supplements and vitamins

People may make use of vitamins, supplements, foods, and other natural healthcare products to help treat symptoms related to CLL. Though some individuals may find success, many natural supplements and vitamins do not have clinical approval.

The FDA does not regulate the production of supplements or nutrition for CLL, so a person should look for third-party-reviewed supplements.

In addition, there are potentially severe drug interactions that can happen if someone takes supplements or vitamins alongside chemoimmunotherapy or targeted therapy without first talking with their doctor.

Mind and body interventions

Mind and body interventions may help decrease stress, which may then help the body function better. It can also help people improve their quality of life.

Examples of mind and body interventions include:

Energy-based therapies

According to the Leukemia & Lymphoma Society, energy-based therapies focus either on the body’s energy or on harnessing magnetic fields or other outside energy sources.

The goal is to channel good energy into the body to promote healing. As with other complementary therapies, no definitive evidence supports its use.

Learn about a form of energy-based therapy called Reiki.

Manipulative body-based therapy

Manipulative body-based therapy involves moving the body in certain ways to promote health and well-being. It may help treat stress, pain, or anxiety.

Examples of this type of therapy include chiropractic treatments, reflexology, or therapeutic massages.

Diet

Some evidence exists that suggests diet can have a positive or negative effect on CLL. For example, according to a 2018 study comparing the Western diet, Mediterranean diet, and prudent diet, a person following a Western diet had a higher chance of developing CLL.

The Western diet generally includes:

  • high fat foods and dairy products
  • fast food and other processed foods
  • sugary foods and drinks
  • refined grains
  • processed meats
  • salty and sugar-filled snacks

The prudent and Mediterranean diets focus on fresh vegetables, fruits, low fat dairy, whole grains, and lean proteins.

Regardless of diet, a person should always try to stay hydrated. This helps protect the kidneys and flush out excess drugs in the system if a person is receiving treatment for CLL.

A doctor will likely tailor a person’s treatment based on their age, stage of cancer, and overall treatment goals. They will also consider how well someone is responding to other treatments and any notable health history they may have.

A younger person may prefer a more aggressive approach to help prolong their life.

A person with higher function and fewer health issues may also prefer a more aggressive approach to help prolong their life. This might include therapies such as chemoimmunotherapy, which may cause more severe side effects.

A person with more functional impairments or more health issues may not be able to manage certain treatment options. They can discuss the advantages and disadvantages of these treatments with their doctor, and balance them against their quality of life.

In any case, it is important for a person to take an active part in their treatment planning and process. This can help them feel more in control and give them more say.

Asking questions of healthcare providers can help when making treatment decisions. A person should consider asking for clarity about what treatments are available, the likelihood of success, and how it may alter their quality of life.

In the United States, doctors and researchers typically use the Rai staging system. This system has five stages, from 0 to 4. The higher the stage, the more advanced a person’s CLL typically is.

A person can discuss with their doctor which treatment options make the most sense for their current stage of CLL.

A person should talk with their doctor about any unusual symptoms they experience. They may be a result of medication side effects or complications related to CLL, such as if it spreads to other tissues in the body.

Since a person with a CLL has a higher chance of infection, a doctor may recommend antibiotics. If fatigue is an issue, a doctor will help find and treat the source of fatigue.

A person may wish to note down extra symptoms they are experiencing before doctor’s appointments. This can help them have a more productive discussion.

CLL treatments involve several methods that can help ease a person’s symptoms and slow the progression of their cancer. These include immunotherapy, targeted therapy, and stem cell transplants.

A person’s age, cancer stage, symptoms, and overall health can affect their treatment. A person can talk with their doctor about the best treatment option for their condition.