Chronic Lymphocytic Leukemia Treatment Options

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By Jeyashree Sundaram (MBA)

Treatment options for chronic lymphocytic leukemia (CLL) rely on different factors such as the phase of the cancer, symptoms manifested, patients’ choice, and the age and comprehensive health of the patient.

Early Stage Treatment for CLL

Standard treatment is not provided to people with beginning stage of CLL that does not exhibit any symptoms. Nevertheless, there are researches in process to find the effectiveness of early treatment. A few studies have stated that “the treatment for early stage CLL is not helpful in extending the life of the patient.”

Before starting treatment, the doctor observes the patient’s condition and concludes on the choice of treatment to be provided when CLL escalates. Medically, this process is called “watchful waiting.” Every month the blood sample of the patient is tested to examine the status of the condition. This time of observation is useful to treat infections caused by the disease and generally take care of the overall health.

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Types of Treatment for Intermediate Stages

When the doctor notices an advance in CLL, which escalates to the intermediate phase, the following treatments are provided:

Chemotherapy: The drug treatment that attempts to destroy the cancer cells by inhibiting their ability to grow and multiply is known as chemotherapy. Depending on the condition of the patient, the doctor may utilize a single chemotherapy drug or a combination of drugs. The chemotherapy drugs used in treatment of CLL are;

Pentostatin
Chlorambucil
Cladribine
Cyclophosphamide
Fludarabine.

Therapy with targeted drug: Targeted drug therapy is the method that focuses on the specific genes, proteins, and tissue environment of the cancer cells. Here, the specific cancer cells are destroyed without causing much damage to the other normal cells. The targeted drugs that play a vital role in treating chronic lymphocytic leukemia are;

Obinutuzumab (Gazyva)
Alemtuzumab (Campath)
Idelalisib (Zydelig)
Ibrutinib (Imbruvica)
Ofatumumab (Arzerra)
Lenalidomide (Revlimid)
Rituximab (Rituxan).

Stem cell transplantation: Affected stem cells in the bone marrow cause diseased lymphocytes. To destroy these stem cells, powerful chemotherapy drugs are used. After the process, healthy blood stem cells from an adult donor are injected into the patients’ blood. These new stem cells reach the bone marrow and start forming new healthy blood cells. This type of transplantation is used only when other treatments fail to cure CLL. Also, for severe forms of chronic lymphocytic, cell transplantation is used.

Bone marrow stem cell transplantation is divided into two categories depending upon the source of cell replacement: autologous (AUTO) and allogeneic (ALLO).

AUTO is the procedure where transplantation is done with the patient’s own stem cell, while ALLO is the process of receiving stem cells from a donor. ALLO is commonly used for young patients in whom other treatment options have failed or where patients have a greater risk of having CLL again.

Radiation therapy: Physicians who are experts at providing radiation therapy are known as radiation oncologists. Radiation therapy is a process by which high-energy X-rays are used to kill the cancer cells. This therapy consists of specific treatments given in a period of time. Though radiation therapy is effective, it is not frequently used to treat CLL, as the condition is found almost all over the body.

This therapy is known to be very useful to reduce the size of the swollen lymph nodes and spleen. This can help patients to be relieved of the symptoms of CLL. Radiation therapy may give rise to side effects such as skin reactions, upset stomach, diarrhea, and fatigue. Some of these side effects may last only till the treatment period and cease afterward.

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Secondary Treatment Through Supportive Care

The role of supportive care is to block or to make the patients completely recover from the symptoms of chronic lymphocytic leukemia. The supportive care for CLL comprises the following.

Screening of cancer: The physician determines the patient’s risk of developing other types of cancer. In such case, the doctor suggests screening for signs of any other cancer. Sometimes, the doctor might recommend for a skin examination to check for signs of skin cancer.

Vaccinations: Vaccinations are frequently recommended to avoid infections and their risk.

Health monitoring: During or immediately after the completion of treatment for CLL, the patient is advised to attend regular checkups and also for monitoring for other health problems.

Medical care that provides gradual relief from pain and from other signs of illness can also be done by the physician or by community health workers, like those involved in palliative care.

The objective of CLL treatment is to destroy all the cancer cells that are found in the blood, marrow, or in any other part of the body, by making use of heavy-dose chemotherapy, radiation therapy, and with blood cell transplantation to produce healthy bone marrow cells.