“CLL is a cancer of the immune system. Many people with CLL won’t need to start treatment for a long time because it’s slow-growing.”

Once the cancer begins to grow, there are many available treatment options that can help people achieve remission. This means people can experience long periods of time when there’s no sign of cancer in their bodies.

The exact treatment option that you’ll receive depends on a variety of factors. This includes:

  • Does your CLL have any symptoms?
  • The stage of the CLL is based on the results of blood tests and physical exams.
  • Your age.
  • Your overall health.

While there’s no cure for CLL yet, breakthroughs in the field are on the horizon.

Doctors typically stage CLL using a system called the Rai system. Low risk CLL describes people who fall in “stage 0” under the Rai system.

The lysy, spleen, and liver are not enlarged in stage 0 The red blood cell and platelet counts are normal.

If you have low risk CLL, your doctor (usually a hematologist or oncologist) will likely advise you to “watch and wait” for symptoms. This approach is also called active surveillance.

Someone with low risk CLL may not need further treatment for many years. Some people will never need treatment. You’ll still need to see a doctor for regular checkups and lab tests.

Intermediate risk CLL describes people with stage 1 to stage 2 CLL, according to the Rai system. People with stage 1 or 2 CLL have enlarged lymph nodes and potentially an enlarged spleen and liver but close to normal red blood cell and platelet counts.

Patients with stage 3 or stage 4 cancer are described as high risk CLL. You may have an enlarged body. Red blood cell counts are low. In the highest stage, the platelet counts may be low.

If you have a high risk of CLL, your doctor will recommend that you start treatment immediately.

Chemotherapy and immunotherapy

In the past, the standard treatment for CLL included a combination of chemotherapy and immunotherapy agents, such as:

  • A combination of two drugs.
  • FC plus an antibody immunotherapy known as rituximab (Rituxan) for people younger than 65
  • For people older than 65, bendamustine and rituximab are included.
  • “The combination of the two drugs in this case is alemtuzumab. If the first round of treatment doesn’t work, these options may be used.”

Targeted therapies

A better understanding of the biology of CLL has led to a number of targeted therapies. Targeted therapies are drugs that are directed at specific CLL cells.

There are drugs that are targeted for CLL.

  • ibrutinib (Imbruvica): targets the enzyme known as Bruton’s tyrosine kinase, or BTK, which is crucial for CLL cell survival
  • venetoclax (Venclexta): used in combination with obinutuzumab (Gazyva), targets the BCL2 protein, a protein seen in CLL
  • idelalisib (Zydelig): blocks the kinase protein known as PI3K and is used for relapsed CLL
  • duvelisib (Copiktra): also targets PI3K but is typically used only after other treatments fail
  • acalabrutinib (Calquence): another BTK inhibitor approved in late 2019 for treating CLL

Monoclonal antibody therapies

onoclonal antibody therapies are a type of treatment in which theonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonalonoclonal They help your immune system fight cancer.

There are several treatments for CLL that target the CD20 and CD52.

  • rituximab (Rituxan): targets CD20, often used with chemotherapy or targeted therapy as part of the initial treatment or in the second-line treatment
  • obinutuzumab (Gazyva): targets CD20, used with venetoclax (Venclexta) or chlorambucil (Leukeran) for patients with previously untreated CLL
  • ofatumumab (Arzerra): targets CD20, usually used in patients whose disease has not responded to prior treatments and is given in combination with chlorambucil (Leukeran) or FC
  • alemtuzumab (Campath): targets CD52

Blood transfusions

You may need to receive blood transfusions to increase your count.

Radiation

Radiation therapy uses high energy particles or waves to help kill cancer cells and shrink painful enlarged lymph nodes. Radiation therapy is rarely used in CLL treatment.

Stem cell and bone marrow transplants

Your doctor may recommend a stem cell transplant if your cancer doesn’t respond to other treatments. A stem cell transplant allows you to receive higher doses of chemotherapy to kill more cancer cells.

The damage to your bone marrow can be caused by higher doses of chemotherapy. You will need to get additional stem cells or bone marrow from a healthy donor.

There are many approaches being investigated to treat people with CLL. The FDA recently approved some of them.

Drug combinations

In May 2019, the FDA approved venetoclax (Venclexta) in combination with obinutuzumab (Gazyva) to treat people with previously untreated CLL as a chemotherapy-free option.

In April 2020, the FDA approved a combination therapy of rituximab (Rituxan) and ibrutinib (Imbruvica) for adult patients with chronic CLL.

“It is more likely that people will be able to do without the drug in the future. Those who can’t tolerate harsh side effects of Chemotherapy need to use non- Chemotherapy treatment regimen.”

CAR T-cell therapy

One of the most promising future treatment options for CLL is CAR T-cell therapy. CAR T-cell therapy, which stands for chimeric antigen receptor T-cell therapy, uses a person’s own immune system cells to fight cancer.

“The procedure involves changing a person’s immune cells to better fight cancer. The cells are put back into the body to fight off the cancer.”

CAR T-cell therapies are promising, but they have risks. There is a risk of cytokine release syndrome. The CAR T-cells cause this inflammatory response. If not treated, some people can experience severe reactions that can lead to death.

Other drugs under investigation

There are currently clinical trials for drugs that are targeted for CLL.

  • The drug is called Zanubrutinib.
  • Entospletinib is a drug.
  • tirabrutinib is a drug.
  • umbralisib is a drug.
  • Isrceptuzumab (UC-961).
  • Ublituximab is a drug.
  • Pembrolizumab is a drug.
  • nivolumab is a drug.

“Some of the drugs may be approved for treating CLL once clinical trials are completed. If current treatment options aren’t working for you, talk to a doctor about joining a clinical trial.”

Clinical trials evaluate the efficacy of new drugs as well as combinations of already approved drugs. These new treatments may work better for you than the ones currently available. Hundreds of clinical trials are currently ongoing for CLL.

Many people who receive a diagnosis of CLL won’t actually need to start treatment right away. Once the disease starts to progress, you have many treatment options available. There’s also a wide range of clinical trials to choose from that are investigating new treatments and combination therapies.