It may be hard to understand what comes next after a diagnosis of chronic lymphocytic leukemia. You will have to work with your healthcare team to come up with a treatment plan.
People with CLL interact with a variety of healthcare professionals. Depending on the type of therapy you receive, you may also work with a radiation oncologist or surgical oncologist.
It is important to have honest discussions with your healthcare team about your treatment plan. This can help you stay involved in the decisions that are made about your treatment.
Here are six questions to help you discuss your options with your doctor.
The type of treatment used for CLL will depend on a number of factors, including the disease stage and the symptoms you are experiencing.
People with CLL who need treatment will usually start taking medication. CLL can be treated with a variety of targeted agents and drugs. The treatments may be used together.
The treatment regimen most commonly used to treat CLL are:
- Acalabrutinib with or without obinutuzumab.
- Ibruvica is a drug.
- venetoclax plus obinutuzumab.
rituximab and other drugs may be used in CLL treatment combinations.
For people who have not yet received any treatment for their CLL, targeted treatment is preferred over Chemo. This type of therapy works by targeting the cells that cause the disease. This helps reduce the effects.
Depending on the potential consequences that may occur, other types of treatment may also be used. If the only part of the body affected is the scupl or lymph nodes, radiation therapy or surgery may be used.
If the blood becomes too thick, a procedure called leukapheresis can be used to remove cells.
A person with CLL may be referred for a stem cell transplant if they are very likely to progress. Stem cell transplant and leukapheresis will be used together.
The treatment you and your doctor decide on is dependent on a number of factors. Your doctor may want to discuss personal factors that will affect your treatment experiences, including:
- Cancer features: The type of treatment you receive may depend on how far your cancer has progressed, as well as whether certain types of genetic mutations can be detected in cancer cells.
- Your underlying health: Age and other underlying conditions, such as kidney disease, can affect how you respond to treatment and influence the likelihood of treatment success.
- Your personal treatment goals: CLL most commonly affects older adults, and the median age at diagnosis is
70 years. This may influence people’s priorities for treatment. Some people may wish to extend their life as long as possible, while others may prioritize comfort over longevity.
It is important to consider how treatment is administered and what support you need when discussing treatment options.
While you can take acalabrutinib and ibrutinib at home, healthcare professionals need to administer them at a clinic. It may be helpful to have a support person who can provide transportation.
Depending on your symptoms and blood counts, your doctor may recommend a watch-and-Wait approach.
This approach is called active monitoring. Your doctor will not start treatment until you have a change in symptoms. They will perform regular medical exams and blood work to make sure the disease is stable and to catch any signs of progression.
The watch-and-wait approach is used for people who have minimal changes in their blood values and no other symptoms of disease.
This approach avoids the negative impacts of other forms of early CLL treatment and is good for people with low risk for progression.
People undergoing CLL treatment are at risk of infections.
“White blood cells are responsible for many typical immune responses in CLL. People with CLL are at increased risk for infections because they can’t produce the antibodies that are needed to fight infections.”
Before starting treatment, your doctor may recommend you get vaccinations for flu, shingles, and COVID-19.
CLL can affect the bone marrow and lead to problems with bleeding and clotting, so low blood cell counts are common. There is often supportive care available to manage these problems.
It is important to discuss side effects with your doctor when you are considering treatment options. You might expect some other side effects with CLL treatments.
- Dehydration, nausea, vomiting, or loss of appetite are some of the issues that can occur in the bicyle.
- There is a throbbing head.
- There are disorders of the heart rhythm.
- If you are treated with the medication venetoclax, you may have a tumor lysis syndrome.
- If you are treated with the drug.
In general, a cure for CLL is very rare. One study published in 2016 reported that people who received the CLL treatment regimen of fludarabine, cyclophosphamide, and rituximab maintained long periods of disease remission lasting up to 12.8 years after treatment.
While these results are encouraging, this treatment regimen is not for everyone. The treatment combination is tough, and people who are 65 or older or have poor kidney function may have difficulty tolerating the regimen.
That’s not to say that outlooks aren’t promising with other treatment options. From 2012 to 2018, nearly
Relapse after initial treatment is common in CLL, with most people experiencing a recurrence of their disease within 5 years of starting treatment.
In many cases, your doctor may suggest a different regimen made up of the medications. Depending on how quickly your disease returns, they may suggest a more aggressive form of treatment.
“Clinical trials of treatments that have shown promise for CLL but are not yet approved for everyday use may be in your doctor’s possession.”
There are many treatment options for CLL.
It is important to come prepared with questions to make sure you get all the information you need to make an informed decision when discussing options with your healthcare team.