Options for Treating Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell). Chronic lymphocytic leukemia (also called CLL) is a cancer of the blood and bone marrow that usually gets worse slowly. CLL is one of the most common types of leukemia in adults. It often occurs during or after middle age; it rarely occurs in children. 

Chronic lymphocytic leukemia is described as asymptomatic, symptomatic or progressive, refractory, or recurrent. In asymptomatic CLL, the leukemia causes no or few symptoms. With symptomatic or progressive CLL, the leukemia has caused significant changes to blood counts or other serious symptoms. With recurrent CLL, the leukemia has recurred, or come back, after a period in which the cancer could not be detected. In people with refractory CLL, the leukemia does not get better with treatment.

After chronic lymphocytic leukemia has been diagnosed, tests are done to find out whether the cancer has spread. Staging is the process used to find out how far the cancer has spread. In CLL, the leukemia cells may spread from the blood and bone marrow to other parts of the body, such as the lymph nodes, liver, and spleen. It is important to know whether the leukemia cells have spread in order to plan the best treatment.

Treating CLL  Different types of treatment are available for people with chronic lymphocytic leukemia. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for people with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. If you’ve been diagnosed with CLL, you may want to think about taking part in a clinical trial. Some clinical trials are open only to people who have not started treatment.

Six types of treatment are used for CLL.

• Watchful waiting is closely monitoring a person’s condition without giving any treatment until signs or symptoms appear or change. This is also called observation. Watchful waiting is used to treat asymptomatic and symptomatic or progressive CLL.
• Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer, such as a group of lymph nodes or the spleen. This treatment may be used to reduce pain related to a swollen spleen or lymph nodes.
• Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body. This is called systemic chemotherapy.
• Targeted therapy is a type of cancer treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Different types of targeted therapy are used to treat CLL.
• Immunotherapy is a treatment that uses a person’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This cancer treatment is a type of biologic therapy.
• Chemotherapy with bone marrow or peripheral blood stem cell transplant. Chemotherapy is given to kill cancer cells. Healthy cells, including blood-forming cells, are destroyed by the cancer treatment. A bone marrow or peripheral blood stem cell transplant are treatments to replace the blood-forming cells. Stem cells (immature blood cells) are removed from the blood or bone marrow of the person with cancer or a donor and are frozen and stored. After chemotherapy is complete, the stored stem cells are thawed and given back to the person with cancer through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.