As you approach the time to start treatment, the following sections of this guide highlight the top options recommended by CLL specialists. There isn’t a single best choice. 

We have listed below the available options in each line of treatment. In the context of cancer, including CLL, a "line of treatment" refers to a specific type of therapy used to treat the disease. As the cancer progresses or initial treatments become ineffective, different lines of treatment are employed.

The initial therapy administered is known as first-line treatment. It is typically the most effective option, but if it fails to control the cancer or its effects diminish, a second-line treatment is initiated. In cases where both first- and second-line treatments are unsuccessful, a third-line treatment is considered, and this process continues as needed.

Your CLL specialist can help determine which treatment best suits your individual needs in each disease stage. Factors like insurance coverage and personal preferences will also play a role in your decision. Click here to read considerations when selecting a treatment. To learn about specific therapies, click the treatment to learn more about it. 

Fixed-Duration & Continuous-Duration Therapies

Treatments for CLL are usually classified as fixed-duration or continuous-duration therapies. 

Fixed-duration therapies are administered over a set period and then discontinued, meaning the patient receives them only for a predesignated period. Because most CLL patients achieve remission from fixed-duration therapies, this one-and-done approach allows patients to have a treatment break until new therapy is needed.

Continuous-duration therapies are taken either until you are not able to tolerate the medicine anymore or the CLL cells in your body become resistant to the therapy, leading to a relapse.

First-Line and Second-Line Treatments 

• Fixed-duration therapy
  • Venetoclax (Venclexta) + obinutuzumab (Gazyva)
  • Venetoclax + rituximab (Rituxan)
• Continuous-duration therapy
  • Covalent BTK inhibitors (acalabrutinib [Calquence], zanubrutinib [Brukinsa], ibrutinib [Imbruvica])
  • Venetoclax by itself 

Third-Line Treatments 

• Fixed-duration therapy
  • CAR T-cell therapy liso-cel (Breyanzi)
• Continuous-duration therapy
  • Non-covalent BTK inhibitor (pirtobrutinib, Jaypirca)
• Treatment in clinical trials