Treatment
CLL develops slowly, so you may not need to start treatment until you have symptoms or there are signs that your disease has progressed. Here are some of the procedures your doctor may recommend to treat CLL.
Watchful Waiting/Active Surveillance
Your doctor may recommend "watchful waiting" or "active surveillance" to treat early-stage CLL. In patients with no symptoms, the benefits of treating early stage CLL do not outweigh the side-effects of treatment. These patients will be monitored closely for cancer progression. If the doctor detects any cancer progression, treatment will be recommended.
Chemotherapy
Chemotherapy is the use of drugs to treat rapidly growing cancer cells in an effort to destroy them. Your doctor may try different combinations of chemotherapy drugs or multiple cycles, depending on your specific case. However, chemotherapy is rarely used in treating CLL.
Radiation Therapy
Radiation therapy uses waves of high energy rays to destroy cancer cells. Radiation therapy is not commonly used as a primary treatment for CLL, but may be used to treat enlarged internal organs and areas of bone weakened by invasion of CLL cells. May also be used as palliative treatment for relief from pain. Your doctor may also recommend undergoing low-dose radiation treatment to your entire body before a stem-cell transplantation.
Stem-cell Transplantation
Stem cell transplantation is used in some patients with CLL. This type of transplant is a lower intensity type called a non-myeloblative transplant. These transplants use less aggressive chemotherapy that only aims to suppress the immune system enough to prevent the rejection of the transplant.
Targeted Therapy
Some cases of CLL contain cells that express certain proteins. A form of targeted therapy called monoclonal antibodies specifically target these proteins. Three new medications given by mouth that target specific enzymes in the CLL cells have been recently approved for the treatment of CLL in certain circumstances. They include BTK inhibitors such as ibrutinib, acalabrutinib, and zanubrutinib and BCL2 inhibitors such as venetoclax and CD20 antibody therapy such as obinutuzumab.
CAR-T Immunotherapy
One approach to immunotherapy currently being studied in clinical trials involves engineering a patient’s own immune cells to recognize and attack their tumors. T-cells are a type of immune cell collected from the patient’s own blood. After collection, the T-cells are genetically engineered to produce special receptors on their surface called chimeric antigen receptors (CARs). These genetically engineered cells are then re-infused into the patient’s bloodstream. After re-infusion, the T-cells multiply in the patient’s body and with guidance from their engineered receptor, are able to recognize and kill cancer cells.
CAR-NK Immunotherapy
Recently, a new type of immunotherapy called CAR NK therapy is being studied (investigated) and tested in clinical trials. This type of treatment enhances the cancer-fighting power of NK cells, called Natural-Killer cells. NK cells are part of our immune system and they patrol our bodies for abnormal cells like cancer and kill them. The NK cells are taken from the blood of an umbilical cord donated by the parents after their baby’s birth and added to a CAR, (chimeric antigen receptor). The new CAR NK cells recognize a target on the surface of invisible cancer cells and attack.
Splenectomy
Your spleen is an organ in your abdomen that filters your blood cells. In CLL, your spleen may become enlarged as CLL cells collect there, causing it to press on other organs. In severe cases, if the swelling is out of control, your doctor may recommend surgery to remove your spleen. This is very rare and is used in special situations only.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
