Types of CLL Treatment

Current therapies do not offer patients a cure for CLL, but there are treatments that help manage the disease. Doctors use several types of approaches and treatment for adults with CLL, some at different stages:

  • Watch and wait
  • Chemotherapy and drug therapy
  • Radiation therapy
  • Splenectomy
  • Supportive care
  • Clinical trials

Some people can have their CLL managed for long periods of time just by being observed under the supervision of their doctor. This is known as ‘watch and wait.’  During ‘watch and wait,’ your doctor  monitors your condition with regular physical exams and lab tests. You won't take any CLL treatment during this period. This approach includes medical exams and regular blood tests to determine whether the disease is stable or progressing. It is important to pay close attention to any new signs or symptoms that may occur and to make your doctor aware of them.  Active treatment will begin when or if the disease starts progressing.

Many CLL patients feel uncomfortable with waiting because they know that they have cancer, yet are not being treated right away. This is very different approach to the way we have been taught to think about cancer treatment. Watch and wait is the standard of care for people who have a low-risk (slow-growing) disease with minimal changes in their blood counts and no symptoms. The watch and wait approach lets you avoid side effects from treatment until you actually need it. Many studies have compared the watch and wait approach to an early treatment approach for people with low-risk CLL. They have found no benefit of early treatment for that group of CLL patients.

Some people can have their CLL managed for long periods of time just by being observed under the supervision of their doctor. This is known as ‘watch and wait.’  During ‘watch and wait,’ your doctor  monitors your condition with regular physical exams and lab tests. You won't take any CLL treatment during this period. This approach includes medical exams and regular blood tests to determine whether the disease is stable or progressing. It is important to pay close attention to any new signs or symptoms that may occur and to make your doctor aware of them.  Active treatment will begin when or if the disease starts progressing.

Many CLL patients feel uncomfortable with waiting because they know that they have cancer, yet are not being treated right away. This is very different approach to the way we have been taught to think about cancer treatment. Watch and wait is the standard of care for people who have a low-risk (slow-growing) disease with minimal changes in their blood counts and no symptoms. The watch and wait approach lets you avoid side effects from treatment until you actually need it. Many studies have compared the watch and wait approach to an early treatment approach for people with low-risk CLL. They have found no benefit of early treatment for that group of CLL patients.

During chemotherapy, treatment is designed to damage or kill leukemic cells. Chemotherapy targets both the CLL cells and the healthy cells which can lead to side effects such as low blood counts, nausea, vomiting or rashes. Generally, the side effects are mild to moderate. You should report any side effects to your health care team so that they help you address them. Doctors commonly combine two or more chemotherapy drugs to treat CLL. Each drug type works in a different way to kill the cancerous cells. Combining drug types can increase their effectiveness.

Targeted cancer therapies are also used to treat CLL. Targeted therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules on the surface of the cancer cells that are involved in the growth, progression and spread of cancer. Because they are designed to target and attack specific substances, they tend to leave normal cells unharmed.

Monoclonal Antibody Therapies (a type of targeted therapy)

A monoclonal antibody is an immune protein made in a laboratory that is designed to target a specific molecule on the surface of CLL cells. The monoclonal antibody targets a molecule and attaches itself to the cell and thereby identifies it for the immune system to destroy. Drug therapy using monoclonal antibodies can be an effective treatment and may have less side effects than chemotherapy. Many of the chemotherapy combinations also include monoclonal antibodies.

Radiation is sometimes used to shrink large lymph node masses or masses in locations that interfere with the function of a neighboring body part, such as the kidney, the gastrointestinal tract or the throat.

Though rarely used for CLL treatment, radiation therapy is sometimes used to relieve pain caused by an enlarged lymph node, spleen or other organ. Also called radiotherapy, this painless treatment uses X-rays or other high-energy rays to kill cancer cells. This reduces the size of swollen lymph nodes and organs.

A splenectomy is the procedure done to remove the spleen – an organ located in the upper left portion of your abdomen that contains groups of lymph nodes. The spleen’s main function is to filter old and worn out cells from the blood. When your spleen becomes enlarged because of CLL, not only can it cause discomfort, but it can sometimes lower your blood cells to dangerous levels.

If your spleen is removed, other organs like the lymph nodes and the liver can perform most of its functions, although you'll be at higher risk of infection. Spleen removal may also help improve your blood cell counts. However, doctors use splenectomy selectively since it's only beneficial if your spleen is affected by CLL.

You may receive supportive care to prevent or treat chronic lymphocytic leukemia (CLL) symptoms and therapy side effects. Common methods of supportive care for CLL include taking antibiotics and receiving blood cell growth factors.

CLL therapy often corrects CLL-related low white blood counts. But if you go through a long period of low white-cell counts after treatment, your doctor may give you agents known as blood cell growth factors to increase your white cell levels. These laboratory-produced agents are similar to substances found naturally in our blood that help red cells, white cells and platelets grow.

Finding the Best Treatment Approach

The treatment your doctor recommends for you is based on several factors: your CLL stage, your physical exam, lab test results and overall health. The goal of CLL treatment is to slow the growth of the cancer cells, provide long periods of remission and to help you feel better if you have infections, fatigue or other symptoms.

As you develop a treatment plan with your doctor, oncologist and care team, be sure to discuss:

  • The results you can expect from treatment
  • Potential side effects, including late-term effects and long-term effects
  • The possibility of participating in a clinical trial, where you'll have access to advanced medical treatment that may be more beneficial to you than standard treatment

When to Begin Treatment

Your doctor may advise you to begin treatment if one or more of the following changes are evident when compared with your prior test results and physical exam:

  • A relatively rapid increase in the number of lymphocytes in your blood
  • A decrease in the number of platelets in your blood
  • Lymph nodes that are getting larger
  • A spleen that's increasing in size
  • Worsening anemia
  • CLL symptoms (such as fatigue, night sweats, weight loss, fever, etc.)

Several of these factors are often present at the same time.

People who have symptomatic intermediate and high-risk (faster-growing) CLL are usually treated with chemotherapy and/or targeted drug therapy using monoclonal antibodies. Combining chemo drugs with monoclonal antibodies is another effective way to treat CLL.

Refractory Leukemia

The term, refractory leukemia, is used to describe CLL that doesn't result in a remission (but may be stable) or that gets worse within six months of the last treatment. Most people treated for refractory CLL often have good-quality years of remission after more treatment.

However, some patients don't respond to the standard CLL chemotherapy treatment. These include patients whose:

  • Disease progressed quickly despite treatment
  • CLL cells have a deletion in the short arm of chromosome 17 (17p-)

While there are new treatments and treatment combinations available for refractory CLL it is important to doctor about all of your treatment options including the possibility of participating in a clinical trial. There are now specific treatment guidelines as well clinical trials specifically for patients with the 17p deletion.

Relapsed Leukemia

"Relapsed CLL" is the term for disease that responded to therapy but, after six or more months, stopped responding. Treatment guidelines for people with relapsed CLL are generally the same as treatment for newly diagnosed people. Most people treated for relapsed CLL often have good-quality years of remission after more treatment.

To learn more, visit www.lls.org.

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