Treatment options for chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is a type of cancer that starts from cells in the bone marrow and moves into the blood. Because CLL is chronic, meaning it continues over time, it can take years before a patient begins to show symptoms or the disease is detected.

Compared to acute leukemias, which develop quickly, the chronic forms progress more slowly and are typically considered incurable. Sometimes, a patient will have to undergo a series of treatments. Thankfully, there are many available options.

Watchful waiting for CLL

When the cancer is in an early stage, “watchful waiting” is typically recommended. That means healthcare providers do nothing while keeping a close eye on how the cancer progresses. The reason is that at this stage, progression can be quite slow.

That approach changes, however, for CLL diagnosed at a later stage. It also changes for people who have signs of an aggressive or faster-moving form of CLL.

During stages I to IV of the disease, treatments can include:

• Chemotherapy, drugs that kill cancer cells or slow their growth
• Targeted therapy, drugs that target cancer cells specifically
• Radiation for swollen nodes
• Surgery for an enlarged spleen

Chemotherapy for CLL

Chemotherapy can involve a number of medications taken by mouth, injected into the blood, or injected into spinal fluid. This last treatment is rare in CLL and used only if the cancer is found in the fluid of the brain and spinal cord.

Patients receive chemotherapy in bursts separated by longer periods of rest. These periods of treatment and rest are called cycles and usually last three to four weeks. The number of cycles a patient receives will vary.

Chemotherapy drugs keep cells from dividing, which is how they inhibit cancer cell growth. But they don’t discriminate between cells. That means they also interfere with the production of healthy cells. The side effects of chemo are related to its effects on healthy cells. They can include nausea and vomiting, hair loss, and low blood cell counts.

A group of drugs called monoclonal antibodies target a certain type of white blood cell for destruction. They’re often used in combination with chemotherapy drugs. Their side effects are similar to those of chemotherapy drugs. But they also raise the risk for a serious viral infection.

Targeted therapies for CLL

Drugs that specifically target parts of cancer cells are called targeted therapies. When they’re used for CLL, they either prevent tumor cells from dividing or shorten their lifespan. Either way, the result is fewer cancer cells. These drugs also have side effects, including low blood cell counts, gastrointestinal distress, body aches, fatigue, and irregular heartbeat.

A serious but rare side effect of chemotherapy and targeted therapies can be tumor lysis syndrome. It can lead to kidney failure as well as heart and nervous system problems.

Bone marrow or stem cell transplant for CLL

CLL can recur or keep progressing even when it’s being treated. A person may run out of treatment options or max out the upper dose for chemotherapy or targeted therapies.

In some cases, a bone marrow or stem cell transplant is possible. They are rarely used, and then only in younger patients with aggressive disease.

Your healthcare provider will work to ensure that you receive the best care for your CLL. They can also help you manage any side effects that may come with treatment.