Chronic Lymphocytic Leukemia - The Leukemia & Lymphoma Society

A person with CLL is usually treated by a hematologist or an oncologist. People are
advised to consult with a doctor who specializes in treating patients with leukemia
and to discuss their most appropriate treatment options—including whether or not
participation in a clinical trial is recommended.
Watch and Wait. People with CLL who have minimal changes in their blood
counts and no symptoms are usually managed with observation alone. This
approach includes medical examinations and periodic testing to determine whether
the disease is stable or beginning to progress. People with CLL being treated with a
watch and wait approach are counseled by their doctors to seek medical assistance
if they develop fevers or other signs of infection or illness. When, or if, the disease
begins to progress, active treatment is started.
People are often concerned when they receive a diagnosis of CLL and then learn
that they will not begin treatment right away. It is important to know that the
watch and wait approach is the current standard of care for people with CLL who
have minimal changes in their blood counts and no symptoms. Many studies have
compared the watch and wait approach to an early treatment approach for people
with low-risk CLL. To date, no benefits of early treatment for people with low-risk
CLL have been shown. Several studies have confirmed that the use of alkylating
agents in patients with early-stage disease does not prolong survival. There are also
risks of early treatment including potential side effects and treatment complications.
Patients may build up a resistance to the drugs used and would not be able to use
them again when treatment for progressive disease is necessary. Deferred treatment
versus early treatment for people with CLL who are symptom-free is an area of
ongoing study in clinical trials.
Many patients take alternative medicines during this time period. The active
ingredient of green tea (EGCG) has been studied preliminarily as a therapy to
prevent CLL progression and has shown very modest results but reasonable safety.
Other agents have not been studied extensively in this area. Patients should discuss
taking such alternative medications with their doctors. For more information
about alternative therapies, see the free LLS publication Integrative Medicine &
Complementary and Alternative Therapies as a Part of Blood Cancer Care.
Drug Therapies. Patients who have symptomatic, intermediate- and high-risk
disease are usually treated with chemotherapy and/or monoclonal antibody therapy.
The choice of recommended treatment generally depends on the patient’s overall
health status, genetic markers in the leukemia cells and the stage of his or her
disease. Age may be a factor for certain types of therapy. Given the importance of
genetics in picking the correct therapy for CLL, it is important that FISH studies
are done to look for del (17p) and del (11q) prior to starting treatment for CLL.
The following therapies may be used to treat people with newly diagnosed CLL,
relapsed CLL or refractory CLL (see Relapsed or Refractory CLL on page 17).
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