Chronic lymphocytic leukemia (CLL) can often be put into remission (reduced or no signs or symptoms of CLL present) with newer non-chemo targeted therapies listed below. With the current treatment options CLL does, however, often resurface after at most 5 years in remission to once again require treatment. There are potential CLL cure therapies (the cancer does not come back) like CAR T-cell therapy currently in clinical trials for CLL. To read more about CAR T-cell therapy and how to join a clinical trial, see here: What is CAR T-Cell Therapy?
About 1/3 of CLL patients will need treatment at the time of diagnosis, 1/3 may not need treatment immediately but will later on, and the remaining 1/3 may never need treatment as CLL often progresses slowly.
Treatment for CLL begins once one of the following issues arises: lymph nodes are enlarged, spleen and/or liver are enlarged, or red blood cell and/or platelet counts are low (read more about the staging system of CLL for when to start treatment here: CLL Staging Process).
If one of the above signs is not present, CLL treatment does not start. Rather, the patient and their care team monitor the patient's health over time called the "watch and wait" period. Patients are encouraged to live their lives as normal and keep in contact with their medical team regarding any concerns they may have. The reason behind choosing watch and wait as opposed to beginning treatment at the time of diagnosis without signs present is because the length and health-related quality of patient life has not been found to be impacted by waiting.
Once signs arise to a point that requires treatment, below are non-chemo CLL treatment paths patients can expect whether for first-time or follow-up therapy (as of 2023 per NCCN guidelines). Medicine names with a brief description are listed, followed by preferred CLL treatment paths. Treatment paths are separated by if the patient does or does not have chromosome 17 deletion (del[17p])/TP53 mutation.
To get the most accurate care for your CLL, find your CLL specialist. Need help? Take a look at HealthTree’s CLL Specialist Directory to locate an expert near you. Need financial support to visit a specialist (travel costs, housing costs, medicine costs)? See here for financial options to help get you the treatment you need.
The following are all non-chemo treatment options. Chemotherapy is rarely used to treat CLL thanks to recent medical advances.
First time being treated (one of the following):
Second and third-line regimens:
If BTK inhibitors and venetoclax don’t work:
First time being treated (one of the following):
Second and third-line regimens for CLL with del(17p)/TP53 mutation:
If BTK inhibitors and venetoclax don’t work:
Why are some medicines used in a combination?
What is 17p deletion and TP53 mutation?
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