Treatment options and prognosis for chronic lymphocytic leukemia (CLL) depend on the stage of the disease, the risk category, and other factors. Seattle Cancer Care Alliance (SCCA) experts offer comprehensive CLL care, including advanced treatments and new options available only through clinical studies.
Treatment Tailored to You
Doctors often consider CLL a chronic, incurable illness that will be treated on and off over several years according to each patient’s individual needs. Some people with CLL can live for years without treatment, but most will need treatment eventually. Of those who are treated, most achieve remission, often for months or years, but the disease usually returns at some point. Your SCCA team will tailor your treatment to your exact situation—at the time of diagnosis and as your disease and health change over time.
The main types of treatment for CLL are:
- Watchful waiting
- Targeted therapy
- Bone marrow transplant
The goals of therapy are:
- To achieve long-lasting remission (which may mean complete remission—no symptoms or clinical signs of disease—or partial remission—50 percent reduction in symptoms and signs of disease)
- When the disease is not in remission, to slow the growth of CLL cells and manage symptoms
Treating Low-Risk or Intermediate-Risk CLL
If your disease is low risk or intermediate risk without any symptoms, your doctor may talk with you about an option known as watchful waiting. This may be the best option for older adults with CLL also. During watchful waiting, you will have regular blood tests, you will be closely monitored for changes in your physical health and any onset of or increase in symptoms, and you may receive supportive care.
If you are uncomfortable with watchful waiting, or if you choose this approach and experience stress from not having treatment for your disease, discuss your feelings with your doctor. If your disease worsens, your doctor will discuss other treatment options with you.
Treating High-Risk CLL
If your disease is high risk or is progressing rapidly, you will need more aggressive treatment, such as chemotherapy, targeted therapy, and bone marrow transplant. With the advent of effective combination-chemotherapy regimens, novel antibodies, and new targeted agents, a majority of CLL patients can be successfully treated and have a normal quality of life between their treatments.
Treating Recurrent or Refractory CLL
If your disease comes back after treatment (recurrent CLL) or doesn’t respond to initial treatment (refractory CLL), you may receive additional treatment. If you had a good response to initial treatment and the response was long lasting, your doctors may treat you with the same drugs; otherwise, you will likely be treated with different drugs.
People with CLL often receive supportive care for symptoms and problems related to the disease and its treatment. For example, to prevent or treat infections you may be given antibodies, antibiotics, vaccines, and anti-viral drugs. Transfusions, steroids, and drugs that stimulate the immune system may be used to treat low blood counts that are common in CLL.
Some people with a lot of CLL cells may have problems with circulation. Leukapheresis—treatment to lower the number of leukemia cells—may be used prior to chemotherapy or targeted therapy to immediately treat this circulation problem as well as to prevent tumor lysis syndrome. Tumor lysis syndrome is caused by the breakdown of large numbers of tumor cells, which release substances into the bloodstream that may damage the kidneys, heart, and liver. It can occur when people with a lot of leukemic cells are first treated with chemotherapy or targeted therapy. Doctors that specialize in treating leukemia are well aware of this potential complication and have methods to reduce the risk.
Access to clinical studies conducted by researchers at SCCA founding organizations—Fred Hutch and UW Medicine—is one reason why many patients come to SCCA for treatment. The goal of clinical studies, also known as clinical trials, is to develop more effective lifesaving treatments in the fight against leukemia. Areas of research include testing new targeted therapies—treatments that specifically target cancer cells—as well as testing new combinations of targeted therapies with and without chemotherapy to prolong the “disease-free” periods between treatments.
For some people, taking part in a clinical study may be the best treatment choice. At any time, SCCA has studies ongoing that are evaluating new treatments for CLL. Be sure to ask your doctor if a clinical study is right for you. For more information about participating, see our patient guide to clinical studies.