Chronic lymphocytic leukaemia treatment
How is CLL treated?
The treatment chosen for your disease will depend on several factors including the stage of your disease, whether or not you have symptoms of your disease, how quickly your disease is progressing, and your age and general health. Traditionally the Rai and Binet staging systems have been used to estimate prognosis in CLL. Using these systems, patients are assigned to one of three major subgroups:
- Stage A (0) refers to early disease where in many cases people haven’t got any symptoms and don’t require treatment
- Stage B (I-II) & C (III-IV) refer to more advance disease which usually requires treatment.
Increasingly, treatment decisions may be influenced by many prognostic factors, which may put some people at a higher risk of disease progression than others regardless of the stage of their disease. In helping you make the best treatment decision, your doctor will consider all information available, including the details of your particular situation, to prescribe the best course of treatment. If treatment is needed the principle aims of treatment are two-fold: to bring about a long-lasting remission, and to prevent and reduce symptoms of the disease.
Many people with CLL, particularly in the early stages of disease, have no symptoms and don’t require any treatment. Instead the doctor may recommend an ‘actively monitor’ strategy (sometimes called ‘watch and wait’) involving regular check-ups and blood counts to carefully monitor your health. This strategy may also be appropriate in more advanced stages of CLL if your blood counts remain stable.
Treatment usually starts only once the disease begins to progress, or causes troublesome symptoms. Many people with CLL have the disease for years without it causing any problems and some people diagnosed with CLL will never require any treatment. There is a general agreement that most people with advanced stage CLL (Rai III and IV, Binet B and C) will need to be treated. Treatment may involve the use of:
- monoclonal antibody therapy
- stem cell transplantation
- experimental treatments available through clinical trials.
Chemotherapy may be given either in tablet form or intravenously, through a vein in your hand or arm. For patients who may benefit from more intensive treatment, a combination of two or more chemotherapy drugs may be used. Combinations of drugs are usually given in several cycles (or courses) with a rest period in between each cycle. This is to allow your body to recover from the side effects of the drugs. In most cases you won’t need to be admitted to hospital for treatment as it is usually given in the hospital’s day treatment centre. Sometimes, depending on the type of chemotherapy being given and your general health, you may need to be admitted for a short while.
More recently, improved results have been achieved by combining chemotherapy with a monoclonal antibody like alemtuzumab or rituximab. This treatment works by helping a person’s own immune system to recognise CLL cells as foreign and kill them. Monoclonal antibodies are given as intravenous infusions, usually in hospital day treatment centres. Side effects are generally mild and well-managed and can include fever, chills and mild skin reactions. Monoclonal antibodies may be given on their own or combined with chemotherapy.
A range of supportive therapies are available to treat symptoms of CLL. These include antibiotics to prevent and treat infections, and blood and platelet transfusions to restore levels of red cells and platelets. Steroids (corticosteroids) are commonly used in combination with the chemotherapy regimens prescribed to treat CLL.
For a very small number of people with CLL (mainly younger people with aggressive disease) a stem cell transplant may be used. This treatment, while offering the prospect of a cure, carries serious risks and is usually only offered if your doctor feels it will be of most benefit to you.