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
There are six types of treatments that doctors
- watchful waiting
- targeted therapy
- radiation therapy
- chemotherapy with a bone marrow or peripheral stem cell transplant
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.
Active surveillance of the condition means that if a person’s condition worsens, healthcare professionals will be able to give prompt treatment.
Targeted therapies are drugs or other substances that attack specific types of cells, such as cancer cells.
This form of treatment
Chemotherapy drugs kill cancer cells but
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.
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
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.
Doctors have used venetoclax (Venclexta) combined with obinutuzumab (Gazyva) to treat CLL since
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
- 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
- pentostatin, cyclophosphamide, and Rituxan
- Venclexta and Gazyva
- Venclexta with Rituxan
Other drugs that are currently under investigation include:
- lenalidomide (Revlimid)
- ublituximab (TG-1101)
- umbralisib (Ukoniq)
- zanubrutinib (Brukinsa)
- cirmtuzumab (UC-961)
- orelabrutinib (ICP-022)
- pirtobrutinib (LOXO-305)
- Ukoniq and TG-1101
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
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.