Is Chemotherapy Used to Treat CLL/SLL?

Although chemotherapy is no longer the standard of care for CLL/SLL, learn about certain cases in which it may still be used for people with this cancer. 

Is Chemotherapy Used for CLL? 

As of the mid-2000s, chemotherapy (a form of cancer treatment that kills quickly dividing cells) is now rarely used to treat chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). This is because modern targeted therapies such as BTK inhibitors and venetoclax have proven to be far superior in their effectiveness over chemotherapy for these patients and have fewer treatment-related side effects. 

It is important to know that this field is advancing and changing constantly, and general oncologists might not always know the latest recommendations for your specific type of cancer. Please speak with a CLL specialist to help evaluate your treatment options. Need help finding one? 

Click here to review HealthTree’s specialist directory

However, some people with CLL/SLL may have received chemotherapy regimens even since targeted therapies have become the new standard of care. Although rarely used, this article will discuss some of the cases in which chemotherapy regimens are still considered to treat CLL/SLL. 

When Chemotherapy May Still Be Considered to Treat CLL/SLL

Cases in which chemotherapy may be recommended to treat CLL/SLL include: 

• You are unable to be treated with targeted therapies and are not eligible to join clinical trials 

• A quick response to treatment is needed 

• Other treatments you tried were not successful 

• You receive chemotherapy as a pre-treatment for another therapy like CAR T-cells or a stem cell transplant 

• People with CLL who have experienced Richter transformation may have been treated with chemotherapy regimens in the past. Specialists are finding that chemotherapy is not an effective option for these patients. To learn more about Richter transformation and improved treatment options, click here

• Limited resources: Certain parts of the world may not have access to targeted therapies for CLL/SLL, and chemotherapy is still used. Traveling to a location that administers targeted therapies for CLL may help overcome this obstacle

What Types of Chemotherapy are Used for CLL/SLL? 

Types of chemotherapy combinations for people with CLL/SLL may include: 

• Fludarabine, cyclophosphamide, and rituximab (FCR)

• Bendamustine and rituximab (BR) 

These treatments are administered intravenously (via an IV). A timeline example for an infusion would be: 

• Bendamustine (chemotherapy) is administered intravenously over 10 minutes on the first and second days of each month for up to 6 months 

• Rituximab (monoclonal antibody given alongside the chemotherapy) is administered intravenously over 3-4 hours on the first day of each month for 6 months 

Common side effects may include low blood counts, hair loss, mouth sores, loss of appetite, nausea, and vomiting. Ask your doctor about ways to manage side effects. You can also click here to learn about side effect management strategies recommended by other patients. 

One thing to note is that people with CLL/SLL who have a del(17p)/TP53 mutation do not have favorable outcomes with chemotherapy. If you have this type of CLL, ask your doctor about clinical trials you may be eligible to join. You can also click here to learn about other treatment options available if you are not eligible for standard CLL care.  

Conclusion

In summary, although chemotherapy is now rarely used for people with CLL/SLL, certain circumstances may place it as a treatment option. Some of these cases include if standard CLL therapies have not worked, if you are preparing to receive CAR T-cell therapy, or if you are preparing for a stem cell transplant. Talk with your CLL specialist to identify the best treatment for you. 

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Sources: 

• Chemotherapy for Chronic Lymphocytic Leukemia (CLL) 

• Practical Management of Richter Transformation in 2023 and Beyond 

• Typical Treatment of Chronic Lymphocytic Leukemia

• AbbVie News Center 

• Bendeka (Bendamustine) Prescribing Information

• Rituxan (Rituximab) Prescribing Information