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Treatments and drugs
By Mayo Clinic staffYour treatment options for chronic lymphocytic leukemia depend on several factors, such as the stage of your cancer, whether you're experiencing signs and symptoms, your overall health, and your preferences.
Treatment may not be necessary in early stages
People with early-stage chronic lymphocytic leukemia typically don't receive treatment, though clinical trials are evaluating whether early treatment may be helpful. Studies have shown that early treatment doesn't extend lives for people with early-stage chronic lymphocytic leukemia. Rather than put you through the potential side effects and complications of treatment before you need it, doctors carefully monitor your condition and reserve treatment for when your leukemia progresses. Doctors call this watchful waiting. Waiting doesn't make future treatments less effective.
About one out of every three people who have chronic lymphocytic leukemia diagnosed at the earliest stages will never need treatment.
Your doctor will devise a checkup schedule for you. You may meet with your doctor and have your blood tested every few months to monitor your condition.
Treatments for intermediate and advanced stages
If your doctor determines your chronic lymphocytic leukemia is progressing or is in the intermediate or advanced stages, your treatment options may include:
- Chemotherapy. Chemotherapy is a drug treatment that kills cancer cells. Chemotherapy treatments can be given through a vein in your arm or taken in pill form. Depending on your situation, your doctor may use a single chemotherapy drug or you may receive a combination of drugs. Side effects depend on what chemotherapy drugs are used. Common side effects include fatigue, low blood cell counts and a risk of frequent infections.
- Targeted drug therapy. Targeted drugs are designed to take advantage of the specific vulnerabilities of your cancer cells. Chronic lymphocytic leukemia cells have a variety of proteins on their surfaces. Targeted therapy drugs are designed to bind to a specific protein as a way to target and kill leukemia cells. Two targeted therapy drugs routinely used in treating chronic lymphocytic leukemia are rituximab (Rituxan), which is used in combination with chemotherapy drugs, and alemtuzumab (Campath), which is used alone or in combination with other drugs. Side effects of these drugs include fever, chills and infections.
- Bone marrow stem cell transplant. Bone marrow stem cell transplants use strong chemotherapy drugs to kill the stem cells in your bone marrow that are creating diseased lymphocytes. Then healthy adult blood stem cells are infused into your blood, where they travel to your bone marrow and begin making healthy blood cells. A "mini" bone marrow stem cell transplant is similar to a standard stem cell transplant, but it uses lower doses of chemotherapy drugs. Bone marrow stem cells may be a treatment option for people who aren't helped by other treatments. For certain people with very aggressive chronic lymphocytic leukemia, however, bone marrow stem cell transplant is an important treatment option.
Clinical trials
Clinical trials are studies to test new treatments and new ways of using existing treatments. While they give people with chronic lymphocytic leukemia a chance to try the latest treatments, clinical trials don't guarantee a cure. Ask your doctor whether any clinical trials are available to you. Examples of treatments being studied in clinical trials include:
- Early treatment for people with high-risk chronic lymphocytic leukemia. Some people with chronic lymphocytic leukemia will never need treatment. Others may experience a highly aggressive disease that requires treatment soon after diagnosis and that may lead to a shortened life. Doctors are using a variety of prognostic tests to gauge a person's risk of aggressive chronic lymphocytic leukemia. Although the standard approach to treatment for people with early-stage chronic lymphocytic leukemia is watchful waiting, clinical trials are evaluating whether early treatment with more-modern therapies may be beneficial for people with tests that indicate they will experience a more aggressive chronic lymphocytic leukemia.
- New combinations of existing drugs. Researchers are also studying new combinations of chemotherapy drugs. Because many people with chronic lymphocytic leukemia are older and may have other health problems that prevent them from undergoing standard chemotherapy, doctors hope combinations involving drugs with fewer side effects may prove useful.
- A drug similar to thalidomide. The drug thalidomide became infamous for causing birth defects in babies whose mothers took the drug during pregnancy. Later it was discovered that thalidomide was helpful in treating cancers. This led to the creation of drugs that work similarly. Lenalidomide (Revlimid) is approved for treating other blood and bone marrow cancers, and doctors are studying its use in chronic lymphocytic leukemia.
- Other new drugs. Many other drugs are being tested as treatments for people with chronic lymphocytic leukemia, including drugs that have proved useful in treating other types of cancer.
- Montserrat E, et al. Chronic lymphocytic leukaemia: A short overview. Annals of Oncology. 2008;19(suppl):vii320.
- Caligaris-Cappio F, et al. Novel insights in chronic lymphocytic leukemia: Are we getting closer to understanding the pathogenesis of the disease? Journal of Clinical Oncology. 2008;26:4497.
- Elphee EE. Caring for patients with chronic lymphocytic leukemia. Clinical Journal of Oncology Nursing. 2008;12:417.
- Dighiero G, et al. Chronic lymphocytic leukaemia. The Lancet. 2008;371(9617):1017.
- Nabhan C, et al. Controversies in the front-line management of chronic lymphocytic leukemia. Leukemia Research. 2008;32:679.
- Chronic lymphocytic leukemia treatment (PDQ) patient version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/CLL/patient/allpage/print. Accessed Oct. 13, 2008.
- Hallek M, et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: A report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute Working Group 1996 guidelines. Blood. 2008;111:5446.
- SEER stat fact sheets. Surveillance Epidemiology and End Results. http://seer.cancer.gov/statfacts/html/clyl.html. Accessed Oct. 15, 2008.
- Questions about treatment. The Leukemia & Lymphoma Society. http://www.leukemia-lymphoma.org/graphics/National/Allquestionsworksheets/QuestionsabouttreatmentPS172R.pdf. Accessed Oct. 15, 2008.
- Campath (prescribing information). Cambridge, Mass.: Genzyme Corp.; 2007. http://www.fda.gov/cder/foi/label/2007/103948s5070lbl.pdf. Accessed Oct. 15, 2008.
- Rituxan (prescribing information). San Francisco, Calif.: Genentech; 2008. http://www.fda.gov/cder/foi/label/2008/103705s5256lbl.pdf. Accessed Oct. 15, 2008.
- Cancer-related fatigue. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/fatigue.pdf. Accessed Oct. 15, 2008.
- Shanafelt TD (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 12, 2008.
