Which treatment for chronic lymphocytic leukaemia (CLL)
This page gives you an overview of the treatments for chronic lymphocytic leukaemia. There is information on
Which treatment for chronic lymphocytic leukaemia
CLL is a disease of remission and relapse. In remission, you have no sign of CLL and no symptoms. Relapse is when the leukaemia is active again, with symptoms. Your doctor will probably get your leukaemia under control (in remission), and you may not need treatment for a period of time. With CLL this can last for years. When the leukaemia comes back, you have more treatment. Many people with CLL can have further remissions. The remissions tend to get shorter, the more treatment you have.
Treatment in early CLL
You may have no symptoms when you are first diagnosed with CLL. So your specialist will probably suggest you do not have treatment at this time. If your CLL starts to get worse, your doctor will suggest treatment.
Initial treatment
For CLL, this ‘first line’ treatment is chemotherapy. Your doctor may suggest using various chemotherapy drugs, or biological therapy . They may recommend radiotherapy or surgery to remove the spleen.
Intensive treatment
After chemotherapy, some people have more intensive treatment to try to stop CLL coming back. This means having a bone marrow or stem cell transplant.
You can view and print the quick guides for all the pages in the Treating CLL section.
Your doctor will take into account the type of CLL that you have as well as the factors below, when they are deciding on the best treatment for you
- How far your leukaemia has developed (the stage)
- Your general health
- Your age and level of fitness
Researchers and doctors continue to look for better combinations of current treatments. They are also developing new treatments and testing them in clinical trials. Your doctor may suggest you join a trial. In CancerHelp UK's research section, there is information about clinical trials, including what it is like to take part. You can find details of individual trials in the CancerHelp UK clinical trials database. Choose 'leukaemia: chronic leukaemia' from the drop down menu of cancer types.
CLL is a disease of remission and relapse, like other leukaemias. Remission is where there is no sign of the leukaemia and you have no symptoms. Relapse is when the leukaemia is active again and gives symptoms. Your doctor will probably be able to get your leukaemia under control (in remission) with treatment. You then have a period where you do not need any treatment. With CLL this can last for years. When the leukaemia comes back, you have more treatment. Many people with CLL can have further remissions with more treatment each time the leukaemia comes back. But generally, the remissions tend to get shorter, the more treatment you have.
Like most cancers, the treatment for CLL depends on how far the disease has developed (the stage). CLL can develop very slowly. And many people are already quite elderly when they are diagnosed. Some of them may never need any treatment if the leukaemia is not causing them any problems. Or they may have mild chemotherapy to control the CLL. As CLL can be stable for years, people in this situation may eventually die of something else - something that is not related to their leukaemia.
Some people can have more intensive treatment to try to get rid of their CLL, or control it for longer. This means having a bone marrow or stem cell transplant. Before you can have this type of treatment, your doctor will need to make sure you are fit enough to get through it. Intensive treatments are too risky if you are not fit enough to get through them. There is a possibility that you could die from infection during the treatment, rather than from your leukaemia.
Many people have no symptoms when they are first diagnosed with CLL. Your CLL may have been picked up on a routine blood test for something else.
If you have no symptoms, your specialist will probably suggest that you do not have any treatment at all for the moment. Starting treatment when you have no symptoms is unlikely to help your CLL. It is likely to be better to keep treatments in reserve until you need them. Your doctor or haematologist will monitor you regularly and check your blood cell count. If you start to have symptoms or your CLL starts to get worse, your doctor will suggest treatment.
Doctors also call this 'first line' treatment. For CLL this is chemotherapy. The chemotherapy used most often is a combination of the drugs fludarabine and cyclophosphamide. This combination is often called FC chemotherapy. This works quite well for CLL, but it does have side effects. Another option is a drug called chlorambucil. This is a tablet, which you can take at home, and has very few side effects. You are more likely to have this if you are older and less able to cope with the side effects of FC chemotherapy.
Other options include combining treatments. Your doctor is most likely to suggest these if you are younger. Or if you have had some test results that show your CLL may need more intensive treatment. Your specialist may suggest
- Fludarabine, cyclophosphamide and the biological therapy, rituximab
- A monoclonal antibody called Mabcampath (alemtuzumab)
Rituximab is a fairly new drug and is a type of biological therapy. There is more about rituximab for CLL in this section of CancerHelp UK.
Radiotherapy is hardly ever used now for CLL. But if you are not well enough for chemotherapy, and you have an enlarged spleen that feels uncomfortable, or enlarged lymph nodes that make you feel self conscious, your doctor may suggest radiotherapy. If your doctor doesn't think radiotherapy will help, or if it does not have any effect on the spleen, your doctor may recommend surgery to remove the spleen. This operation is called a splenectomy.
If your CLL does not go completely into remission after chemotherapy, your specialist may suggest treatment with a type of biological therapy called alemtuzumab.
This is still experimental and only a small number of people have intensive treatment for CLL. If you are going to have intensive treatment, you will have chemotherapy first, to try to get your CLL into remission. Remission means you have no sign of the disease on scans or tests. To try to stop the CLL coming back, you will then have a stem cell or bone marrow transplant. This means more chemotherapy and sometimes radiotherapy, followed by a drip (infusion) of someone else's, or possibly your own, bone marrow or blood stem cells.
Doctors call this 'second line' treatment. If your CLL has come back after treatment with a single chemotherapy drug, you may have the same treatment again. Or your doctor may suggest chemotherapy with a different drug, or possibly a combination of drugs, such as CHOP. In particular circumstances, your specialist may decide that more intensive treatment with a stem cell transplant could help.
CLL that transforms into prolymphocytic leukaemia or lymphoma (Richter's syndrome) is also treated with chemotherapy.
Some people develop CLL that becomes resistant to chemotherapy. That means it stops responding to the treatment. Your doctor may suggest 'third line' treatment with high dose steroid treatment or treatment with a monoclonal antibody called alemtuzumab. Your doctor may also suggest these treatments if you have a lot of very enlarged lymph nodes.
This is a very rare disease and is a type of CLL. It often needs no treatment for a long time after diagnosis. In fact, up to half the people diagnosed with it never need any treatment. In people who do, this is usually because they are getting too many infections. Treatment aims to damp down the immune system, as this helps control the leukaemia. The main treatments used are
- Chlorambucil (as for initial treatment in CLL)
- Steroids
- Methotrexate tablets (this is a chemotherapy drug)
- Ciclosporin
Ciclosporin is a drug that damps down the immune system.
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