There is currently no cure for chronic lymphocytic leukemia. Treatment for chronic lymphocytic leukemia is focused on alleviating symptoms and slowing the progression of the disease.

Treatment for chronic lymphocytic leukemia depends on the stage. Stages are used to describe how much the cancer has worsened or spread.

Stages

Stage 0 – In this stage of chronic lymphocytic leukemia, there are too many white blood cells called lymphocytes without any sign or symptom of leukemia. This is a slow-growing stage.

Stage I – In this stage of chronic lymphocytic leukemia, there are too many white blood cells called lymphocytes and enlarged lymph nodes.

Stage II – In this stage of chronic lymphocytic leukemia, there are too many white blood cells called lymphocytes, and an enlarged liver, spleen, or lymph nodes.

Stage III – In this stage of chronic lymphocytic leukemia, there are too many white blood cells called lymphocytes, not enough red blood cells, and an enlarged liver, spleen, or lymph nodes.

Stage IV – In this stage of chronic lymphocytic leukemia, there are too many white blood cells called lymphocytes, not enough platelets or red blood cells, and an enlarged liver, spleen, or lymph nodes.

Treatments for Different Stages

Chronic lymphocytic leukemia is more commonly classified as:

Asymptomatic, which means without symptoms. Treatment for asymptomatic chronic lymphocytic leukemia is watchful waiting to see when the disease progresses.

Symptomatic, which means there are symptoms. Treatment for symptomatic chronic lymphocytic leukemia may include:

• Watchful waiting
• Targeted therapy
• Immunotherapy
• Bone marrow or Stem Cell Transplant

Progressive, which means the disease has worsened. Treatment for progressive chronic lymphocytic leukemia may include:

• Watchful waiting
• Targeted therapy
• Immunotherapy
• Bone marrow or Stem Cell Transplant

Refractory, which means the leukemia is resistant to certain treatments. Treatment for refractory chronic lymphocytic leukemia may include:

• Targeted therapy alone
• Immunotherapy
• Bone marrow or stem cell transplant
• Radiation therapy as palliative treatment to relieve symptoms

Recurrent, which means the leukemia has returned after treatment. Treatment for recurrent chronic lymphocytic leukemia many include:

• Targeted therapy alone
• Immunotherapy
• Bone marrow or stem cell transplant
• Radiation therapy as palliative treatment to relieve symptoms

Types of Treatments

Treatments for chronic lymphocytic leukemia may include:

• Watchful Waiting
• Radiation Therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy, also called biologics
• Bone marrow or stem cell transplant

Leukapheresis, which is a procedure that reduces the number of white blood cells

Watchful waiting – Watchful waiting is used to monitor a patient with early chronic lymphocytic leukemia who does not yet have any symptoms to see if there is a change.

Radiation therapy – Radiation therapy uses intense, directed X-rays, protons, or other types of radiation to stop cancer cells from growing or to kill cancer cells.

Chemotherapy – Chemotherapy is used with or without steroids, such as prednisone, methylprednisolone, and dexamethasone, and uses drugs that can be given either by mouth or directly into a vein.

Chemotherapy drugs used for the treatment of chronic lymphocytic leukemia may include:

• Fludarabine
• Pentostatin
• Cladribine
• Cyclophosphamide
• Rituximab
• Leukeran
• Bendamustine

Targeted therapy – Targeted therapy uses drugs that are designed to cancer cells. Types of targeted therapies used to treat chronic lymphocytic leukemia include:

Tyrosine kinase inhibitors –Tyrosine kinase inhibitors stop tumors from growing. Tyrosine kinase inhibitors used for the treatment of chronic lymphocytic leukemia include:

• Acalabrutinib
• Ibrutinib
• Idelalisib
• Duvelisib

BCL2 inhibitor therapy – BCL2 therapy makes leukemia cells become more receptive to anticancer drugs and includes the drug, venetoclax, for the treatment of chronic lymphocytic leukemia.

Monoclonal antibody therapy – Monoclonal antibody therapy stops cancer cells from growing, spreading, or kills cancer cells. Monoclonal antibody drugs for the treatment of symptomatic or progressive chronic lymphocytic leukemia include:

• Rituximab
• Ofatumumab
• Obinutuzumab, either alone or in combination with chemotherapy.

Immunotherapy, which is also called, biologics – Immunotherapy uses the patient’s immune system, or the body’s natural defenses, to fight the cancer. Types of immunotherapy for the treatment of chronic lymphocytic leukemia include:

Immunomodulating agents – Immunomodulating agents increase the ability of the body’s T cells to kill leukemia. Immunotherapy drugs for the treatment of symptomatic or progressive chronic lymphocytic leukemia include lenalidomide, which can be used either alone or in combination with rituximab.

CAR T-Cell Therapy –This is a type of immunotherapy that modifies the body’s T-cells to attack cancer cells and is used to treat symptomatic or progressive chronic lymphocytic leukemia.

Chemotherapy with Bone Marrow Transplant (Stem Cell Transplant) – This treatment first uses chemotherapy to destroy leukemia cells. Next, stem cells are taken from either the blood or bone marrow and returned to the patient via infusion. The new stem cells grow into healthy blood cells.

Leukapheresis – This treatment lowers the high number of cancerous white blood cells in the treatment of chronic lymphocytic leukemia.

Palliative Care

In addition to standard treatments, patients with chronic lymphocytic leukemia may also be treated with palliative care. Palliative care is used to relieve pain and other symptoms to make a patient more comfortable.

Alternative Treatments

Green tea extract in pill form is an alternative treatment for early chronic lymphocytic leukemia that has had some effectiveness, but more study is needed.

Long-Term Follow Up

Ongoing, long-term follow-up is an essential part of the treatment for patients with chronic lymphocytic leukemia because the disease is progressive.

Sources

This content was written by the MediFind Medical Team. Last updated: 6/9/2022