Treatments for chronic lymphocytic leukemia
If you have chronic lymphocytic leukemia (CLL), your healthcare team will create a treatment plan just for you. It will be based on your needs and may include a combination of different treatments. When deciding which treatments to offer for CLL, your healthcare team will consider:
- your age
- your overall health
- your personal preferences
You may be offered the following treatments for CLL.
Watchful waiting is also called active surveillance. It is treatment that involves carefully watching for signs that CLL is progressing. It may be an option if there is evidence of CLL but you don’t have symptoms. Treatment is started if the disease progresses.
Chemotherapy is used as the main treatment for intermediate-risk and high-risk CLL, as well as for relapsed and refractory CLL. It is used to control the blood cell counts, improve anemia (low red blood cell count), improve thrombocytopenia (low platelet count) and to shrink lymph nodes and the spleen.
Chemotherapy is also given if the spleen is larger than normal, or enlarged. Shrinking an enlarged spleen relieves the discomfort caused by it pressing on other organs.
Targeted therapy may be given for intermediate-risk or high-risk CLL and when CLL has recurred or is no longer responding to chemotherapy. Targeted therapy drugs may be given in combination with chemotherapy.
Sometimes surgery is used to remove the spleen (called splenectomy). This may be done if the spleen is enlarged and painful, and chemotherapy or radiation therapy does not shrink the spleen. Removing the spleen may also help to improve blood cell counts.
Radiation therapy may be given to:
- shrink an enlarged spleen if chemotherapy does not work
- relieve pain caused by the growth of leukemia cells in the bone marrow
- shrink enlarged lymph nodes in one area of the body
Stem cell transplant
A stem cell transplant is not a standard treatment for CLL at this time. People who develop CLL are often older and may not benefit from a stem cell transplant. Researchers are studying reduced-intensity transplants to see if they could be used to treat CLL in elderly people.
Supportive therapy is given to treat the complications that usually happen with treatments for CLL and the disease itself. Supportive therapy can include:
- antibiotics, antivirals or antifungals to prevent or fight infections
- infusion of immunoglobulins (IVIG) to prevent recurrent infections
- transfusion of blood products to replace blood cells when counts are low
- growth factors, such as filgrastim (Neupogen), to stimulate the body to make white blood cells
- drugs to bring down high levels of some chemicals in the blood that increase when many cancer cells die at the beginning of treatment (called tumour lysis syndrome)
- leukapheresis to remove large numbers of white blood cells from the blood
Follow-up after treatment is an important part of cancer care. Follow-up visits for CLL are usually scheduled for many years before or after treatment even if there are no signs of the disease. The time between exams may become longer as time goes on, but you will need to have follow-up exams for a long period of time. These visits allow your healthcare team to monitor your progress and recovery from treatment.
Some clinical trials in Canada are open to people with CLL. Clinical trials look at new and better ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
The organ on the upper-left side of the abdomen near the stomach that makes lymphocytes (a type of white blood cell that fights germs, foreign substances or cancer cells), stores blood cells, filters the blood and destroys old blood cells.
A procedure that uses a special machine (pheresis machine) to separate and collect specific white blood cells from withdrawn blood. The remaining blood is then returned to the body.
Leukapheresis is used to lower a very high white blood cell count in people with cancer (leukemia) or to remove white blood cells for transfusion.