Chronic lymphocytic leukemia

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Treatments for intermediate-risk or high-risk CLL

Your healthcare team will suggest treatments and work with you to develop a treatment plan based on the risk level of your chronic lymphocytic leukemia (CLL) and your needs. Intermediate-risk CLL is Rai stage 1 and 2 or Binet stage B. High-risk CLL is Rai stage 3 and 4 or Binet stage C. The following are treatment options for intermediate-risk or high-risk CLL.

Watchful waiting

Watchful waiting is also called active surveillance. You may be offered watchful waiting for intermediate-risk or high-risk CLL if you have few or no symptoms. Treatment is started if there are signs that the disease is progressing or if you develop new symptoms.


You may be offered chemotherapy for intermediate-risk and high-risk CLL. The chemotherapy drugs used alone or in combination include:

  • fludarabine (Fludara)
  • bendamustine (Treanda)
  • cladribine (Leustatin)
  • chlorambucil (Leukeran)
  • cyclophosphamide (Cytoxan, Procytox)
  • pentostatin (deoxycoformycin, Nipent)
  • vincristine (Oncovin)
  • doxorubicin (Adriamycin)
  • mitoxantrone (Novantrone)
  • methotrexate
  • oxaliplatin (Eloxatin)
  • etoposide (Vepesid, VP-16)
  • cytarabine (Cytosar, Ara-C)

A steroid such as prednisone or dexamethasone (Decadron, Dexasone) may be used in combination with chemotherapy.

Targeted therapy

You may be offered targeted therapy for intermediate-risk and high-risk CLL. Targeted therapy is treatment that uses drugs or other substances to target specific molecules (usually proteins) involved in cancer cell growth while limiting harm to normal cells. It may be used in combination with chemotherapy drugs.

The targeted therapy drugs that may be used are:

  • rituximab (Rituxan)
  • alemtuzumab (Campath)
  • ofatumumab (Arzerra)
  • obinutuzumab (Gazyva)
  • ibrutinib (Imbruvica)
  • idelalisib (Zydelig)


Surgery to remove the spleen (called a splenectomy) may be offered for intermediate-risk or high-risk CLL. It is done to improve red blood cell or platelet counts. It is also done to relieve discomfort when the enlarged spleen puts pressure on other organs.

Radiation therapy

You may be offered low-dose external beam radiation therapy for intermediate-risk and high-risk CLL. It is used to shrink an enlarged spleen or swollen lymph nodes in one area of the body.

Supportive therapy

Supportive therapy is an important part of treatment for intermediate-risk or high-risk CLL. It is used to treat the complications that usually happen with treatments for CLL and the disease itself.

Supportive therapies may include:

  • antibiotics, antivirals or antifungals to prevent or fight infections
  • infusion of immunoglobulins (IVIG) to prevent recurrent infections
  • growth factors to help the bone marrow recover from chemotherapy (chemotherapy can affect the bone marrow so it doesn’t make enough healthy blood cells, which can increase the risk for infection)
  • transfusions of red blood cells, platelets, fresh frozen plasma and cryoprecipitate (a product that replaces clotting factors) as needed
  • 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

Clinical trials

You may be asked if you want to join a clinical trial for CLL. Find out more about clinical trials.


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.


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