Chronic lymphocytic leukemia (CLL) is a cancer that primarily affects older adults and usually progresses slowly. This often means that people may not need treatment for some time.

There is no cure for CLL, but researchers have made frequent treatment breakthroughs in recent years and anticipate more in the near future.

When people do require treatment, many different types can lead to remission.

In this article, we look at the various treatment options and advances in treatment for CLL.

CLL is a type of blood and bone marrow cancer where a person’s bone marrow produces too many of a type of white blood cell called a lymphocyte.

The condition progresses slowly, meaning that some people may go long periods without needing treatment.

There are six types of treatments that doctors may recommend to treat CLL. These are:

Watchful waiting

This involves closely monitoring a person’s condition but not giving actual treatment until symptoms appear.

Doctors often use this strategy if a person has asymptomatic CLL, meaning they do not show any symptoms.

Research suggests that early treatment of CLL does not help people live longer. Therefore, the side effects of any treatments at this stage may outweigh potential benefits.

Active surveillance of the condition means that if a person’s condition worsens, healthcare professionals will be able to give prompt treatment.

Targeted therapy

Targeted therapies are drugs or other substances that attack specific types of cells, such as cancer cells.

This form of treatment usually harms fewer healthy cells than other treatment types. Targeted therapies may also have fewer side effects than other kinds of cancer treatment.


Chemotherapy drugs kill cancer cells but may also damage healthy cells. For some people, the side effects of this treatment may be too much.

Radiation therapy

This type of therapy uses high doses of radiation to destroy cancer cells, such as in a group of lymph nodes or the spleen. Doctors do not often recommend radiation therapy for CLL.


The immune system naturally tries to find and kill abnormal cells. Immunotherapy, an alternative treatment to chemotherapy, involves boosting a person’s immune system to fight cancer more efficiently.

Side effects can include experiencing flu-like symptoms or skin reactions at the needle site.

Chemotherapy with a bone marrow or peripheral stem cell transplant

This combines chemotherapy with a transplant of blood-forming cells called stem cells. The procedure involves removing, freezing, and storing immature blood cells from the person or a donor until after the person completes chemotherapy. They then receive them back through an infusion.

Typical treatments for CLL have dramatically changed in recent years. Most treatments are specific to certain proteins found in the cancerous cells in people with CLL.

According to one study, doctors treated CLL using chemotherapy and anti-CD20 antibody-based immunotherapy until recently.

Newer treatments include the use of Bruton’s tyrosine kinase (BTK) inhibitors, B cell lymphoma 2 (BCL-2) inhibitors, and phosphoinositide 3-kinase (PI3K) inhibitors. CD20, BTK, BCL-2, and PI3K are all types of proteins that are tumor markers.

Chimeric antigen receptor T cell therapy

This type of treatment involves changing one type of a person’s immune cells, called T cells, in a lab so that they then bind to cancer cells and kill them.

The process involves removing T cells from the blood and adding a specific gene known as chimeric antigen receptor (CAR) to them. The person then receives an infusion of new cells. These cells bind to an antigen on cancer cells and kill them.

Possible side effects from CAR T cell therapy include cytokine release syndrome, an inflammatory condition with symptoms such as high fever, chills, confusion, low blood pressure, or difficulty breathing.

Drug combinations

Doctors have used venetoclax (Venclexta) combined with obinutuzumab (Gazyva) to treat CLL since 2019. Venetoclax targets BCL-2. This is a protein found in CLL cells that prevents them from dying when they should. Gazyva targets the CD20 protein.

One side effect of this treatment is a serious condition called tumor lysis syndrome. This occurs when tumor cells die off rapidly and their contents spill into the blood, causing changes to levels of chemicals in the blood. People with tumor lysis syndrome may develop damage to their organs, including the kidneys, heart, and liver.

According to the American Cancer Society, doctors commonly prescribe the following medication combinations to treat CLL:

  • acalabrutinib (Calquence) with Gazyva
  • alemtuzumab (Campath) with rituximab (Rituxan)
  • bendamustine and Rituxan
  • chlorambucil and Rituxan
  • fludarabine, cyclophosphamide, and Rituxan
  • high dose prednisone and Rituxan
  • ibrutinib (Imbruvica) with Rituxan
  • Imbruvica and Gazyva
  • Gazyva
  • pentostatin, cyclophosphamide, and Rituxan
  • Venclexta and Gazyva
  • Venclexta with Rituxan

Other drugs that are currently under investigation include:

Many different factors affect treatment options. For example:

  • red blood cell, white blood cell, and platelet counts
  • signs or symptoms that are occuring, such as chills, weight loss, fever
  • the size of a person’s liver, spleen, or lymph nodes relative to normal
  • a person’s age and overall health when they receive a diagnosis
  • the response to initial treatment
  • whether a person is in remission

Clinical trials looking into potential new treatments for CLL are currently ongoing. Clinical trials are carefully controlled research studies that aim to get a clearer idea of whether new treatments or procedures are effective.

Clinical trials are a way for people to access state-of-the-art cancer treatment. People may want to consider participating in one for a number of reasons, such as if standard treatments have not worked for them. Some clinical trials are only open to people who have not yet started treatment.

A person should speak with their doctor or cancer team to determine if they are suitable or eligible to take part in a clinical trial.

Some people with chronic lymphocytic leukemia may not need treatment at first, but when the condition begins to worsen, they have several options.

There have been many breakthroughs in treatment approaches for CLL in the last few years.

There is still no cure for CLL, but many different treatments are available and a number of clinical trials are investigating new options for the future.