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Chronic Lymphocytic Leukemia (CLL) / Small Lymphocytic Lymphoma (SLL)

Treatments for chronic lymphocytic leukaemia (CLL)

Each person’s experience of CLL can be vastly different. As the progression of CLL is slow, it often has no symptoms, and some people may not require treatment right away or ever, while others may need treatment immediately after diagnosis.

A team of healthcare specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).2

The type of treatment that you and your doctor decides on for you will depend on how advanced your CLL is and the result of any genetic testing, as well as your age, general wellbeing, any additional medical conditions, and your needs/preferences.3 Your doctor will determine the prognosis and treatment plan with you after staging the disease.3

As CLL develops very slowly, treatment may not be required when the cancer is in an early stage, and you do not have any symptoms. At this stage you will be under what is called ‘watch and wait’.3

Watch and wait

For those in whom the disease is caught early on, they will be placed under what is known as ‘watch and wait’. It is essentially the time when you have no active treatment following a blood cancer diagnosis.3

Having no active treatments following a diagnosis can be a worrying time, but from being diagnosed onwards you will be monitored through regular blood tests and consultations at hospital or doctors’ appointments. It is at these appointments and through your test results that doctors will be looking for signs of disease progression, and, when the time is right, review your need for treatment.

Even though you may not be receiving any physical treatment for your CLL, you will still receive all the support that you need from your care provider(s) regarding constant disease monitoring, advice and mental health support.

If CLL starts to cause symptoms or is not diagnosed until later, one of the treatments below may be recommended:

Chemotherapy medications have been a mainstay treatment of cancer for many years and are administered either orally or intravenously (through a drip). They work by entering the bloodstream to stop or slow the division of cancerous and healthy cells throughout the body.

These are cancer treatments that have been developed to only target the specific genes and proteins on or within cells that are helping the cancer grow and survive, meaning that they have less effect on healthy cells. Simply put, targeted treatments work to kill the cancerous cell, leaving the healthy cells to thrive.

Most people with CLL who require treatment are treated either with an inhibitor, which targets proteins found on or within the surface of cancer cells, or with chemo-immunotherapy, where a monoclonal antibody treatment is provided in combination with chemotherapy.

Bruton’s Tyrosine Kinase inhibitors (BTKi) target the proteins on the surface of CLL cells called B-cell receptors, which are responsible for the growth of CLL. If these receptors are shut down, the cell dies. These drugs block kinases, which are proteins in cells that normally relay signals (such as telling the cell to grow). BTKi’s are usually taken daily as tablets or capsules for as long as they continue to work.

Monoclonal antibodies treat CLL by targeting proteins on white blood cells called B-lymphocytes (B-cells). This makes the B-cells die. Monoclonal antibodies are usually given with chemotherapy and are ordinarily administered intravenously (via a drip).

Malignant CLL cells continue to grow due to the overproduction of a protein called BCL2. Blocking this protein helps to kill the cells causing CLL, which is what BCL2 inhibitors do. BCL2 inhibitors are usually taken daily as tablets or capsules for as long as they continue to work.

A stem cell or bone marrow transplant is a treatment where donated cells called stem cells are transplanted into your body, so you start to produce healthy white blood cells. It is a procedure that is more rare and is an intensive type of treatment that's not suitable for everyone.

Radiotherapy will not be an option for most people with CLL, as it is a treatment that delivers targeted beams of radiation to a specific area of cancer in the body. It tends to be used if the spleen or specific cluster of lymph nodes become swollen or symptomatic. Radiotherapy is a painless procedure, but it can often result in side effects such as redness at the area, fatigue, nausea and vomiting.

A splenectomy (the removal of the spleen) may be considered as a cause of action for some patients on rare occasions. It usually becomes an option if the spleen has enlarged and starts causing complications, and where other treatment methods have failed to reduce its size. People can live full lives without a spleen, although there is a higher risk of infection.

You may be given blood transfusions as part of a supportive care treatment if you experience severe anaemia or problems with bleeding and bruising, to provide more red blood cells and platelets (clotting cells).

These are usually given to patients who are immunocompromised (have a weakened immune system) and are susceptible to infections (which CLL patients are due to a lowered white blood cell count) and are generally administered in conjunction with chemotherapy which can lower the immune system further.

Granulocyte-colony stimulating factor (G-CSF) is a type of growth factor protein which helps to create more white blood cells. It is normally given when a specific type of immune cells (neutrophils) are below the normal range in your blood. It can be used in conjunction with:

  • chemotherapy to stimulate the bone marrow into creating neutrophils (white blood cells that help fight infection)
  • before a stem cell transplant to encourage the release of stem cells into the blood which can then be collected and used in for the transplant.

It is important to inform yourself as much as possible about the recommended treatments and the possible side effects, for example cardiac risks, as well as considering any pre-existing conditions, to allow your doctor to make a decision that best suits your needs and offers you the greatest quality of life. Don’t hesitate to bring up any concerns and ask your doctor as many questions as possible. If you feel it’s necessary, don’t be shy about asking for a second opinion.

Unfortunately, whilst there is currently no cure for CLL, the disease is completely manageable with a treatment plan that is tailored to your unique situation.

At some point during your CLL diagnosis, you may decide that you do not want to continue with your treatment. This is a decision that is yours to make, but it is highly recommended that you discuss all of your options and decision with your healthcare and treatment team, as well as with your loved ones. In this case, your medical team would focus on providing you with palliative care, making sure you are as comfortable as possible.

Prognosis

The outlook for those with chronic lymphocytic leukaemia (CLL) is dependent upon a number of factors:

  • how advanced it is when diagnosed
  • how old you are when diagnosed
  • your overall general health

Generally for all people with CLL they will survive for five or more years after being diagnosed.12 Though, in recent years, the prognosis for patients has been significantly improved following the introduction of targeted therapies.12

Throughout the journey to find a cure for CLL scientists and researchers have discovered treatments that are much more effective at treating CLL today than they ever have been before.2 They remain committed to continue to work tirelessly towards finding a cure.12

References

[1]
Myeloma UK. Infopack for carers of myeloma patients. Available at: http://www.myeloma.org.uk/wp-content/uploads/2018/03/Myeloma-UK-An-Infopack-for-carers-of-myeloma-patients.pdf. Last accessed April 2021.