Typical Treatment of Chronic Lymphocytic Leukemia
- 3 years ago
Typical Treatment of Chronic Lymphocytic Leukemia
Treatment options for chronic lymphocytic leukemia (CLL) can vary greatly.
Many people live a long time with CLL, but in general it is very hard to cure, and early treatment hasn't been shown to help people live longer. Because of this and because treatment can cause side effects, doctors often advise waiting until the disease is progressing or bothersome symptoms appear, before starting treatment.
If treatment is needed, factors that should be taken into account include the patient’s age and overall health, and prognostic factors such as the presence of deletions in chromosomes 17 or 11, or high levels of ZAP-70 and CD38.
Initial treatment of CLL
Drugs that may be used
Many different drugs and drug combinations can be used as the first treatment for CLL. The options include monoclonal antibodies, other targeted drugs, chemotherapy, and different combinations of these.
Some of the more commonly used treatments include:
Ibrutinib (Imbruvica), alone or with rituximab (Rituxan)
Acalabrutinib (Calquence), alone or with obinutuzumab (Gazyva)
Venetoclax (Venclexta) and obinutuzumab
Venetoclax alone, or with rituximab
Bendamustine and rituximab (or another monoclonal antibody)
High-dose prednisone and rituximab
FCR: fludarabine, cyclophosphamide, and rituximab
PCR: pentostatin, cyclophosphamide, and rituximab
Chlorambucil and rituximab (or another monoclonal antibody)
Obinutuzumab
Ibrutinib and obinutuzumab
Alemtuzumab (Campath), alone or with rituximab
Other drugs or combinations of drugs may also be used.
Radiation or surgery
If the only problem is an enlarged spleen or swollen lymph nodes in one part of the body, localized treatment with low-dose radiation therapy may be used. Splenectomy (surgery to remove the spleen) is another option if the enlarged spleen is causing symptoms.
Leukapheresis
Sometimes very high numbers of CLL cells in the blood cause problems with normal circulation. This is called leukostasis. Chemo may not lower the number of cells until a few days after the first dose, so before the chemo is given, some of the cells may need to be removed from the blood with a procedure called leukapheresis. This treatment lowers blood counts right away. The effect lasts only for a short time, but it may help until the chemo has a chance to work. Leukapheresis is also sometimes used before chemo if there are very high numbers of leukemia cells (even when they aren’t causing problems) to prevent tumor lysis syndrome. (This was discussed in the chemotherapy section.)
Stem cell transplant
Some people who have very high-risk disease (based on prognostic factors ) may be referred for possible stem cell transplant (SCT) early in treatment.
Second-line treatment of CLL
If the initial treatment is no longer working or the disease comes back, another type of treatment often helps. If the initial response to the treatment lasted a long time (usually at least a few years), the same treatment migh
Treatment options for chronic lymphocytic leukemia (CLL) can vary greatly.
Many people live a long time with CLL, but in general it is very hard to cure, and early treatment hasn't been shown to help people live longer. Because of this and because treatment can cause side effects, doctors often advise waiting until the disease is progressing or bothersome symptoms appear, before starting treatment.
If treatment is needed, factors that should be taken into account include the patient’s age and overall health, and prognostic factors such as the presence of deletions in chromosomes 17 or 11, or high levels of ZAP-70 and CD38.
Initial treatment of CLL
Drugs that may be used
Many different drugs and drug combinations can be used as the first treatment for CLL. The options include monoclonal antibodies, other targeted drugs, chemotherapy, and different combinations of these.
Some of the more commonly used treatments include:
Ibrutinib (Imbruvica), alone or with rituximab (Rituxan)
Acalabrutinib (Calquence), alone or with obinutuzumab (Gazyva)
Venetoclax (Venclexta) and obinutuzumab
Venetoclax alone, or with rituximab
Bendamustine and rituximab (or another monoclonal antibody)
High-dose prednisone and rituximab
FCR: fludarabine, cyclophosphamide, and rituximab
PCR: pentostatin, cyclophosphamide, and rituximab
Chlorambucil and rituximab (or another monoclonal antibody)
Obinutuzumab
Ibrutinib and obinutuzumab
Alemtuzumab (Campath), alone or with rituximab
Other drugs or combinations of drugs may also be used.
Radiation or surgery
If the only problem is an enlarged spleen or swollen lymph nodes in one part of the body, localized treatment with low-dose radiation therapy may be used. Splenectomy (surgery to remove the spleen) is another option if the enlarged spleen is causing symptoms.
Leukapheresis
Sometimes very high numbers of CLL cells in the blood cause problems with normal circulation. This is called leukostasis. Chemo may not lower the number of cells until a few days after the first dose, so before the chemo is given, some of the cells may need to be removed from the blood with a procedure called leukapheresis. This treatment lowers blood counts right away. The effect lasts only for a short time, but it may help until the chemo has a chance to work. Leukapheresis is also sometimes used before chemo if there are very high numbers of leukemia cells (even when they aren’t causing problems) to prevent tumor lysis syndrome. (This was discussed in the chemotherapy section.)
Stem cell transplant
Some people who have very high-risk disease (based on prognostic factors ) may be referred for possible stem cell transplant (SCT) early in treatment.
Second-line treatment of CLL
If the initial treatment is no longer working or the disease comes back, another type of treatment often helps. If the initial response to the treatment lasted a long time (usually at least a few years), the same treatment migh