Chronic Lymphocytic Leukemia (CLL): Treatment Choices
There are various treatment choices for chronic lymphocytic leukemia (CLL). Which one may work best for you? It depends on a number of factors. These include the stage of your CLL and the results of certain tests you have. Factors also include if the CLL is causing symptoms, as well as your age, overall health, and what side effects you’ll find acceptable.
Learning about your treatment options
You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.
Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision for you.
Types of treatment for CLL
Different types of treatment have different goals. Here are some of the types of treatment and their goals for people with CLL.
Watchful waiting. This is also called observation. It’s a period when your doctor watches your leukemia closely before treating you. He or she waits until you have symptoms or the disease is clearly progressing. Studies have shown that people with limited disease who aren't having any symptoms don't benefit from early treatment. But they might still be bothered by the side effects of the disease. During this time, your doctor can treat any problems caused by the leukemia, such as infection.
Chemotherapy. This is usually the main way to treat CLL. Its goal is to stop the growth of cancer cells and prevent them from growing again. You may be treated with just one medicine. Or you may receive at least 2 medicines at a time. This is called combination chemotherapy. You have medicines by injection or in pill form. The medicines are often given in cycles. Chemotherapy may also be combined with targeted therapy. Or it may be done along with a stem cell transplant. This is used to help replace cells lost during high-dose treatment. The type and stage of CLL will help determine the way chemotherapy is given.
Targeted therapy. These are medicines that target a specific part of leukemia cells. One example used in CLL is monoclonal antibodies. These are synthetic versions of immune system proteins. The proteins are used to try to kill leukemia cells or slow their growth. Monoclonal antibody therapy is given by IV. Some other types of targeted therapy are taken as pills.
Leukapheresis. This treatment is done by passing blood from an IV through a machine that removes white blood cells, including leukemia cells. The filtered blood, including the remaining cells and plasma, are then returned back to you through another IV. Large numbers of leukemia cells can sometimes cause problems with normal circulation in people with CLL. Chemotherapy is the main treatment to lower the number of these cells, but it can take a few days to lower the cell count. Although the effect of leukapheresis is temporary, it may be advised while waiting for the chemotherapy to work.
Stem cell transplant with high-dose chemotherapy. If the normal doses of chemotherapy don't work, your doctor may need to give you very high doses of chemotherapy. These high doses can damage the stem cells in your bone marrow. Blood stem cells are the "starter" cells for new blood cells. In some cases before chemotherapy, the doctor removes some stem cells from a volunteer donor and freezes them. They are then given to you after treatment to restore your body's lost blood cells. This is called a stem cell transplant.
Radiation therapy. This type of therapy uses high-energy X-rays to kill cancer cells or prevent their growth. It's not often part of the standard treatment for CLL, but your doctor may advise it in certain cases. Radiation may be used right before a stem cell transplant. In rare cases, it may be used to shrink a tumor or an enlarged organ, such as the spleen. A doctor may advise radiation therapy to treat pain from bone damage that leukemia cells can cause.
Surgery. A splenectomy is a surgery to remove your spleen. In rare cases, this may be advised in the treatment of CLL. It doesn’t cure the leukemia, but it can improve symptoms. This may be done to improve blood cell counts or to reduce pressure on other organs caused by a swollen spleen.
Clinical trials for new treatments
Researchers are always finding new ways to treat CLL. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.
Talking with your healthcare providers
At first, thinking about treatment options may seem overwhelming. Talk with your doctors, nurses, and loved ones. Make a list of questions. Consider the benefits and possible side effects of each option. Discuss your concerns with your healthcare providers before making a decision.
March 21, 2017
Alteri, Rick, MD,Cunningham, Louise, RN