Treatment Options for CLL Leukemia
Almost 21,000 Americans are diagnosed with chronic lymphocytic leukemia (CLL)–the most common form of leukemia–every year. CLL affects certain cells called lymphocytes that help your body fight invaders. Because of this, your body might not be able to effectively battle infections and other diseases.
In many cases, CLL symptoms don’t appear for several years, and you might not need treatment right away. In fact, because treatment can cause side effects, patients often don’t start treating CLL until symptoms appear or the disease progresses.
After you’re diagnosed with CLL, you’ll receive blood tests and exams periodically to see if you should start treatment. Your treatment plan depends on your symptoms, the stage of the disease, and any other illnesses you may have. If your doctor thinks it’s time to start treatment, you can work together to find the right therapy, or combination of therapies, for you. There’s no cure for CLL, but remission is possible; remission means there’s no detectable CLL in your blood and you’re not experiencing symptoms. And while many people have recurrences of CLL after periods of remission, treatment advances offer patients more effective therapies, with fewer side effects that lead to longer remissions.
Doctors often recommend targeted therapy as a first-line treatment in the fight against CLL. Targeted therapies block specific proteins inside or on the outside of CLL cells from helping the cells grow and multiply. These drugs include ibrutinib (Imbruvica), idelalisib (Zydelig), and venetoclax (Venclexta).
Side effects tend to be mild, but include diarrhea, nausea, constipation, fatigue, body aches, swelling in hands and feet, and shortness of breath, as well as low blood cell counts. You may be at higher risk of infection while taking these drugs, so let your doctor know of any symptoms.
This relatively new form of treatment uses man-made antibodies to attack cancer cells. These antibodies attach to specific proteins on the surface of cancer cells, helping the immune system to identify and fight the cancer. You may receive a monoclonal antibody by itself, or a combination of chemotherapy and a monoclonal antibody. Examples of monoclonal antibodies include rituximab (Rituxan), obinutuzumab (Gazyva), and ofatumumab (Arzerra).
Side effects vary between the different drugs, but in general, people may experience chest pain, increased heart rate, face and tongue swelling, cough, breathing problems, fever, low white blood cell counts, and, rarely, some more serious issues, including an increased risk of hepatitis B and a condition called tumor lysis syndrome. Your doctor may give you other drugs to reduce and prevent these side effects from occurring.
These anti-cancer drugs are taken orally or are injected into your bloodstream. Chemotherapy drugs kill CLL cells, although often they kill healthy cells as well. Your doctor may recommend this treatment if CLL has spread to other organs. Chemo can cause side effects like hair loss, mouth sores, loss of appetite, and nausea and vomiting, which are usually short-term and disappear after treatment is completed. Your doctor may provide you with drugs that lessen or prevent these side effects. Often, chemo is given in combination with other drugs, like monoclonal antibodies.
Stem Cell Transplant
Typically, chemotherapy, targeted therapy, and monoclonal antibodies are enough to fight off CLL. But in some cases, stem cell transplant is necessary. If you require very high doses of chemotherapy, or, less commonly, radiation therapy, they can severely damage your bone marrow where new blood cells are made. To prevent this, your doctor may perform chemo or radiation followed by a stem cell transplant to replenish stem cells in your body and keep your bone marrow healthy.
The transplanted stem cells can come from your own blood or bone marrow, although leukemia cells may be collected along with the healthy cells. You may also receive a stem cell donation from a donor with the same tissue type as you. Receiving a donor’s stem cells is more common for CLL, although any stem cell transplant comes with the threat of complications or side effects, including a higher risk of infection and the possibility that your body will reject the new stem cells.
In rare cases, CLL results in extremely high levels of white blood cells that actually cause your blood to thicken. If this occurs, a procedure called leukapheresis may be used to filter out these cells. Similar to kidney dialysis, leukapheresis uses a special machine to withdraw your blood, filter it, and then return it to you.
Sometimes, your levels of calcium can drop during the procedure, which can cause numbness and tingling in your hands and feet, as well as around your mouth, and rarely, muscle spasms. Calcium supplements can resolve these issues.
Radiation and Surgery
While radiation therapy and surgery aren’t typical treatments for CLL, they may be used in certain circumstances. Your doctor may recommend radiation therapy to help alleviate your symptoms, or before a stem cell transplant. One surgical procedure, called splenectomy, may be performed if your spleen is enlarged and causing significant symptoms.
Fortunately, treatment advancements for CLL mean you have more options than ever before. Working closely with your doctor is the best way to find effective treatments that manage your symptoms while helping to keep you as healthy as possible.