Chronic lymphocytic leukemia

Treatment

Treatment has changed significantly for chronic lymphocytic leukemia (CLL) since around 2014. Now, most people do very well with newer targeted drugs and immunotherapies — though, for certain patients, conventional chemotherapy and bone marrow transplant remain important options. 

Seattle Cancer Care Alliance (SCCA) offers you access to all CLL treatments. Our experts work as a team to carefully select and sequence treatments to match your specific situation, whether you need targeted therapy, antibodies, cellular immunotherapy, chemo or transplant.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

CLL expertise

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.

Leukemia survival rates

Data collected from cancer centers across the country show that people who begin their leukemia treatment at SCCA have higher survival rates on average than those who started treatment at other centers.

Everything you need is here

We have medical oncologists and hematologists who specialize in CLL; the most advanced diagnostic, treatment and recovery programs; and extensive support.

Innovative leukemia therapies

SCCA is a world leader in leukemia research. Through clinical trials, our doctors and scientists offer new options, like CAR T-cell therapy, a form of immunotherapy made from your own white blood cells, modified to recognize and attack leukemia cells. 

Treatment tailored to you

We view treatment as a collaborative effort. Your SCCA doctor will explain all your options and recommend a personalized treatment plan based on the exact characteristics of your disease (such as the stage, risk level, molecular characteristics and chromosomal mutations) as well as your age, overall health, treatment preferences and lifestyle.

Team-based approach

Your personal team includes an oncologist, nurse case manager and team coordinator. Additional experts — such as an infectious disease doctor, pulmonologist, geneticist, social worker, physical therapist or nutritionist — who specialize in treating people with cancer will be involved if you need them.

Learn More About our Supportive Care Services

Ongoing care and support

Throughout treatment, your team provides follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life.

Learn More About the SCCA Survivorship Clinic

Treatment by CLL risk level

Doctors often consider CLL a chronic illness that will be treated on and off. Some people live for years without any treatment. Most need treatment eventually, and most of them go into remission, often for months or years. 

The goals of CLL therapy are:

  • To achieve long-lasting remission — which may mean complete remission (no clinical signs or symptoms of disease) or partial remission (50 percent reduction in signs and symptoms)
  • To slow the growth of CLL cells and manage symptoms when the disease is not in remission
Treating low-risk or intermediate-risk CLL

If your disease is low risk or intermediate risk without any symptoms, your doctor may recommend watchful waiting. This means you will have regular blood tests, be closely monitored for symptoms or health changes and receive supportive care to help with any effects of CLL. 

Treating high-risk CLL

If your disease is high risk or is progressing rapidly, you will need immunotherapy or targeted therapy. Most people can be successfully treated using new antibodies and targeted drugs and have good quality of life between 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, long-lasting response to initial treatment, your doctors may treat you with the same drugs; otherwise, you will likely be treated with different drugs.

Supportive care

People with CLL often receive supportive care for symptoms and problems related to the disease and to its treatment such as: 

  • Antibiotics, vaccines and anti-viral drugs to prevent or treat infections
  • Transfusions, steroids and drugs that stimulate the immune system to treat low blood counts 
  • Therapy to lower the number of leukemia cells (leukapheresis) to treat circulation problems or prevent complications that may happen when chemotherapy or targeted therapy breaks down a large number of tumor cells (tumor lysis syndrome)

Treatment types

Immunotherapy

Immunotherapies are treatments that harness your immune system to fight your cancer. For CLL, doctors commonly use monoclonal antibodies that target CD20, a protein on the surface of B-cells.

Examples include:

  • Obinutuzumab (Gazyva)
  • Ofatumumab (Arzerra)
  • Rituximab (Rituxan)

As part of clinical trials, our doctors also offer other, novel monoclonal antibodies that target cancer cells.

Researchers at SCCA are also studying CAR T-cell therapy for CLL and other diseases. For this treatment, we remove T-cells from your body, genetically modify them with a chimeric antigen receptor (CAR) that’s based on an antibody, and then return them to your body, where the modified cells attack your cancer. 

New monoclonal antibodies as well as CAR T-cell therapy are available at SCCA in clinical trials for CLL. 

Immunotherapy

Immunotherapies are treatments that harness your immune system to fight your cancer. For CLL, doctors commonly use monoclonal antibodies that target CD20, a protein on the surface of B-cells.

Chemotherapy

Most chemotherapy drugs for CLL are given by infusion through an intravenous (IV) line. Usually they are given in combination with each other or with targeted therapies. 

Your SCCA team will talk with you about the specific drugs we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and connect you with medical and support resources throughout SCCA.

Some of the chemotherapy drugs most commonly used to treat CLL include:

  • Bendamustine (Treanda)
  • Chlorambucil (Ambochlorin, Amboclorin, Leukeran, Linfolizin)
  • Cyclophosphamide (Clafen, Cytoxan, Neosar, Revimmune)
  • Fludarabine (Fludara)
Chemotherapy

Most chemotherapy drugs for CLL are given by infusion through an intravenous (IV) line. Usually they are given in combination with each other or with targeted therapies. 

Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy). 

Monoclonal antibodies like rituximab can be considered both immunotherapies and targeted therapies.

Two other types of targeted therapy are used for CLL.

  • B-cell receptor inhibitors (BCRIs):
    • Ibrutinib (Imbruvica), which has been effective in people with difficult-to-treat disease, including those with recurrent CLL or a deletion in chromosome 17 (17p deletion). It is also approved for previously untreated patients over 65 who have medical conditions in addition to cancer (comorbidities), and it may be an option for younger patients with high-risk genetic features.
    • Idelalisib (Zydelig), which is used in combination with rituximab for relapsed CLL. 
  • BCL-2 inhibitors:
    • Venetoclax (Venclexta), which is used in people with a 17p deletion. 
Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy.

Bone marrow transplant

Your doctors may recommend a bone marrow transplant (also called stem cell or hematopoietic cell transplant) to cure CLL — typically only if:

  • You have high-risk CLL.
  • Your disease has not responded to standard treatments.

For CLL, doctors perform a transplant using stem cells from a donor (allogeneic transplant). (For other diseases, they may use the patient’s own stem cells.) The transplant works in two ways.

  1. After you receive strong chemotherapy to eliminate the CLL, the donor’s healthy stem cells restart your body’s ability to form blood cells.
  2. White blood cells from the donor may recognize as foreign and attack any leukemia cells that remain in your body. 

More people are eligible for allogeneic transplants than ever before, due to advances available at SCCA, such as:

  • Non-myeloablative (reduced-intensity) transplants, which use lower-dose chemotherapy
  • Transplants using stem cells from donated umbilical cord blood or haploidentical (half-matched) donors
Bone marrow transplant

Your doctors may recommend a bone marrow transplant (also called stem cell or hematopoietic cell transplant) to cure CLL — typically only if you have high-risk CLL or you disease has not responded to standard treatments.