Treating Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia (CLL) is a cancer of the blood and bone marrow that usually gets worse slowly. It is one of the most common types of adult leukemia, often occurring during or after middle age. With CLL, the bone marrow makes too many of a type of white blood cell called lymphocytes.
Normally, the bone marrow makes blood stem cells (immature cells) that over time, become mature blood cells. A blood stem cell may become a lymphoid stem cell, which then becomes a lymphoblast stem cell before becoming one of three types of lymphocytes:
- B lymphocytes that make antibodies to help fight infection,
- T lymphocytes that help B lymphocytes make the antibodies that help fight infection,
- And natural killer cells that attack cancer cells and viruses.
In CLL, too many blood stem cells become abnormal lymphocytes, also known as leukemia cells. These leukemia cells are not able to fight infection very well. As the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells and platelets. This may lead to infection, anemia and easy bleeding.
Certain factors affect treatment options and prognosis for CLL:
- Red blood cell, white blood cell and platelet blood counts.
- Whether the liver, spleen or lymph nodes are larger than normal.
- The age and health of the patient at the time of diagnosis.
- Whether there are signs or symptoms, such as fever, chills or weight loss.
- Response to initial treatment.
- Whether the CLL has recurred (come back).
Different types of treatment are available for patients with CLL:
- Observation (closely monitoring the patient’s condition without giving any treatment until signs or symptoms appear or change) is often used to treat asymptomatic or progressive CLL.
- Targeted therapy uses drugs or other substances to identify and attack specific cancer cells and usually causes less harm to normal cells than chemotherapy or radiation therapy.
- Chemotherapy (taken by mouth or injected) enters the bloodstream and kills cells or stops them from dividing.
- Chemotherapy may be followed by a bone marrow or peripheral stem cell transplant to help restore the body’s blood cells.
- Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing and may be used to reduce pain related to a swollen spleen or lymph nodes.
- Immunotherapy (a type of biologic therapy) uses substances made by the body or in a laboratory to boost, direct or restore the body’s natural defenses against cancer.
In addition to standard (currently used) treatments, new types of treatments are being tested in clinical trials, including CAR T-cell therapy, in which the patient’s immune cells are taken from their blood and changed in the laboratory so they will attack cancer cells.
Coping with CLL
Cancer Support Community offers advice to those diagnosed with CLL, including questions to ask their care team:
- What stage is the CLL?
- How fast-growing does the CLL appear to be?
- Do I need to start treatment now? If not, how will we know when to start treatment?
- Does the CLL test positive for any biomarkers (such as TP53 or del[17p]) that help make treatment decisions?
- If I need to start treatment now, what are my options?
- Which treatment do you recommend for me and why?
- What is the goal of each of my treatment options? What are the risks?
- How, where and how often will I receive this treatment?
- How long will I need to be on this treatment?
- How will we know if this treatment is working?
- How will this treatment impact my everyday life? Will I need to miss work/school?
- How much will this treatment cost me? Will it be covered under my insurance? Is there a social worker or financial counselor I could meet with?
- Are there any clinical trials that would be right for me? How do I find out more about them?
- Do I need to go to an academic medical center for my treatment?
- What side effects should I expect (short and long term)? What can we do to manage them?
- Which side effects or symptoms do I need to report to my health care team?
- Whom should I call if I have questions or problems during office hours? After hours and weekends?
- How can I find a counselor or mental health services?
- How can I maintain my health and wellness when dealing with CLL?
- Am I up-to-date on flu, pneumococcal, and VZV vaccines? Are there any “live” vaccines I should avoid?
Financial Assistance for CLL Treatment
The HealthWell Foundation offers a Chronic Lymphocytic Leukemia (CLL) fund to provide medication copayment and insurance premium assistance to eligible CLL patients. HealthWell will provide up to $8,000 in financial assistance to individuals who have household incomes up to 500 percent of the federal poverty level. Grants through the fund assist CLL patients in covering out-of-pocket costs for treatment.
PDQ® Adult Treatment Editorial Board. PDQ Chronic Lymphocytic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Updated 11/25/2020. Available at: https://www.cancer.gov/types/leukemia/patient/cll-treatment-pdq. Accessed 6/9/2021. [PMID: 26389485]
Cancer Support Community. Frankly Speaking About Cancer: Chronic Lymphocytic Leukemia/Small Lymphocytic Leukemia. Accessed 6/9/21.