Treatments for relapsed or refractory chronic lymphocytic leukemia

Relapsed, or recurrent, chronic lymphocytic leukemia (CLL) means that the cancer has come back after it has been treated.

Refractory CLL means that the cancer did not respond to treatment.

Your healthcare team will suggest treatments based on the molecular characteristics of the CLL cells. What you want will also be important when planning treatment.

The most common treatments used for relapsed or refractory CLL are targeted therapy and chemoimmunotherapy.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Chemoimmunotherapy combines chemotherapy with monoclonal antibodies, which are a type of targeted therapy. Chemotherapy uses drugs to destroy cancer cells.

If you have relapsed or refractory CLL that has a 17p chromosome deletion (the short arm "p" of chromosome 17 is missing) or a TP53 gene mutation (the TP53 gene has mutated, or changed), treatment is usually targeted therapy.

The most common targeted therapy drugs offered are:

• ibrutinib (Imbruvica)
• acalabrutinib (Calquence)
• zanubrutinib (Brukinsa)
• venetoclax (Venclexta)
• VR – venetoclax and rituximab (Rituxan and biosimilars)

Find out more about targeted therapy for CLL.

After trying different targeted therapies, you may also be offered a stem cell transplant if you are younger than 70 years old and meet the criteria set by your treatment centre. Find out more about stem cell transplant for CLL.

If you have relapsed or refractory CLL that does not have a 17p chromosome deletion or a TP53 gene mutation, treatment is usually targeted therapy.

The most common targeted therapy drugs offered are:

• venetoclax (Venclexta)
• VR – venetoclax and rituximab (Rituxan and biosimilars)
• ibrutinib (Imbruvica)
• acalabrutinib (Calquence) (may not be covered by all provincial or territorial health plans)
• zanubrutinib (Brukinsa) (may not be covered by all provincial or territorial health plans)

Find out more about targeted therapy for CLL.

If you are younger than 70 years old and have Richter transformation, your healthcare team may suggest a stem cell transplant or a clinical trial. Find out more about stem cell transplant for CLL.

A treatment option still being studied for relapsed or refractory CLL that does not have a 17p chromosome deletion or a TP53 gene mutation is CAR T-cell therapy. CAR T-cell therapy is a type of immunotherapy that takes millions of T cells from a person with cancer. In the lab, they are changed so they have chimeric antigen receptors (CARs) on their surface. These receptors recognize a specific protein (antigen) found on the leukemia cells. The T cells are then given back to the person where they multiply, attack and destroy the leukemia cells. CAR T-cell therapy for CLL may not be available in every province or territory.

You may be asked if you want to join a clinical trial for CLL. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.