Search

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL)

Overview
Treatment Options
Treatments Under Investigation
Clinical Trials
Follow Up
Support
Resources

Overview

Attend an Education Program
Contact the Helpline
Join the Support Network
Order Free Publications
Focus On CLL

Lymphoma is the most common blood cancer. The two main forms of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Lymphoma occurs when cells of the immune system called lymphocytes, a type of white blood cell, grow and multiply uncontrollably. Cancerous lymphocytes can travel to many parts of the body, including the lymph nodes, spleen, bone marrow, blood, or other organs, and form a mass called a tumor. The body has two main types of lymphocytes that can develop into lymphomas: B-lymphocytes (B-cells) and T-lymphocytes (T-cells).

Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are B-cell lymphomas. CLL and SLL are essentially the same disease, the only difference being where the cancer primarily occurs. When most of the cancer cells are located in the bloodstream and the bone marrow, the disease is referred to as CLL, although the lymph nodes and spleen are often involved. When the cancer cells are located mostly in the lymph nodes, the disease is called SLL.

CLL/SLL tends to be an indolent (slow-growing) cancer; however, over time, it can progress to a more aggressive type of lymphoma. Common signs of disease include a swelling of the liver and spleen and enlargement of the lymph nodes in the neck, underarm, stomach, or groin. Other symptoms of CLL/SLL can include fatigue, shortness of breath, anemia, bruising, night sweats, weight loss, and frequent infections. Often, people with CLL/SLL have no obvious symptoms of the disease at diagnosis. Approximately one-third of all CLL/SLL patients will live for years without symptoms.

Treatment Options

What Types of Treatments Are Used in Patients With CLL/SLL?

There are five general types of treatments for patients with CLL/SLL:

  • Watchful waiting (no treatment given) in which the patient is closely monitored to see if/when treatment should be started
  • Drug therapy, which includes one or more of the following types of drugs:
  • Chemotherapy, which affects general cell growth and division
  • Monoclonal antibodies, which can specifically attack lymphoma cells
  • Targeted or biologic therapies, which affect special characteristics of tumor cells
  • Stem cell transplantation
  • Radiation therapy, which uses high-energy radiation to kill lymphoma cells
  • Surgery to remove the spleen (splenectomy)

Treatment is based on the severity of associated symptoms as well as the rate of cancer growth. If patients show no or very few symptoms, doctors may decide not to treat it right away, an approach referred to as "watch and wait" or "watchful waiting." Studies have shown that suitable patients who follow a "watch and wait" approach have outcomes similar to those being treated early in the course of their disease.

There are many current frontline treatment options for CLL/SLL. In general, patients who are older or frail are typically treated with less aggressive regimens than those who are younger and healthier. Stem cell transplantation is a treatment option for certain patients, including those with advanced disease, those with certain high-risk features, or those whose disease has transformed into a more aggressive form. Typically stem cells from a donor are used (called an allogeneic stem cell transplant) but with less toxic treatments as preparation (sometimes called a mini-allogeneic transplant).

Common combination drug regimens used to treat CLL/SLL include:

Table 6.1. Common Drug Regimens for CLL/SLL

    Drug or Regimen
    Abbreviation
     Generic Name of Drugs (Brand Name)
    B Bendamustine (Treanda)
    BR Bendamustine (Treanda)
    Rituximab (Rituxan)
    2CDA Cladribine (Leustatin)
    C Cyclophosphamide (Clafen, Cytoxan, Neosar)
    Chl Chlorambucil (Leukeran)
    CyPred-R    Cyclophosphamide (Clafen, Cytoxan, Neosar)
    Prednisone (Deltasone)
    Rituximab (Rituxan)
    F Fludarabine (Fludara)
    FR Fludarabine (Fludara)
    Rituximab (Rituxan)
    FCR Fludarabine (Fludara)
    Cyclophosphamide (Clafen, Cytoxan, Neosar)
    Rituximab (Rituxan)
    HDMP-R High-dose methylprednisolone (Depo-Medrol, Medlone 21, Medrol, Meprolone, Metrocort, Metypred, Solu-Medrol, Summicort)
    Rituximab (Rituxan)
    Ibrutinib alone Ibrutinib (Imbruvica)
    Idelalisib plus
    rituximab
    Idelalisib (Zydelig)
    Rituximab (Rituxan)
    Obinutuzumab
    plus chlorambucil
    Obinutuzumab (Gazyva)
    Chlorambucil (Leukeran)
    OFAR Oxaliplatin (Eloxatin)
    Fludarabine (Fludara)
    Cytarabine (Cytosar-U, Tarabine PFS)
    Rituximab (Rituxan)
    Ofatumumab
    alone
    Ofatumumab (Arzerra)
    Ofatumumab plus
    chlorambucil
    Ofatumumab (Arzerra)
    Chlorambucil (Leukeran)
    PCR Pentostatin (Nipent)
    Cyclophosphamide (Clafen, Cytoxan, Neosar)
    Rituximab (Rituxan)
    RCHl Rituximab (Rituxan)
    Chlorambucil (Leukeran)
    RCHOP Rituximab (Rituxan)
    Cyclophosphamide (Clafen, Cytoxan, Neosar)
    Doxorubicin/hydroxydaunorubicin (Adriamycin, Rubex)
    Vincristine (Oncovin, Vincasar PFS)
    Prednisone (Deltasone)

     

    Treatments Under Investigation

    Many treatments are currently being tested in clinical trials for both newly diagnosed and relapsed/ refractory CLL/SLL patients. Chemoimmunotherapy agents are being explored as induction therapy in newly diagnosed patients; the efficacy and safety of ibrutinib is being investigated alone or as part of a combination therapy regimen in patients with relapsed and refractory disease. It is critical to remember that today's scientific research is continuously evolving.Treatment options may change as new treatments are discovered and current treatments are improved. Therefore, it is important that patients check with LRF or with their physician for any treatment updates that may have recently emerged.

    Clinical Trials

    Clinical trials are crucial in identifying effective drugs and determining optimal doses for lymphoma patients. Patients interested in participating in a clinical trial should talk to their physician or contact LRF’s Helpline for an individualized clinical trial search by calling (800) 500-9976 or emailing helpline@lymphoma.org.

    Follow Up

    Because CLL/SLL is generally characterized by multiple disease relapses after responses to a variety of treatments, patients in remission should have regular visits with a physician who is familiar with their medical history as well as with the treatments they have received. Medical tests (such as blood tests and computed axial tomography [CAT] scans) may be required at various times during remission to evaluate the need for additional treatment.

    Some treatments can cause long-term effects or late effects, which can vary based on duration and frequency of treatments, age, gender, and the overall health of each patient at the time of treatment. The doctor will check for these effects during follow-up care.

    Survivors and their caregivers are encouraged to keep copies of all medical records and test results as well as information on the types, amounts, and duration of all treatments received. This documentation will be important for keeping track of any effects resulting from treatment or potential disease recurrences. For further information, please review our fact sheet on survivorship issues.

    Support

    A lymphoma diagnosis often triggers a range of feelings and raises many concerns. In addition, cancer treatment can cause physical discomfort. Support groups and online message boards can help patients connect with other people who have lymphoma. One-to-one peer support programs, such as LRF's Lymphoma Support Network, match lymphoma survivors (or caregivers) with volunteers who have gone through similar experiences.

    Resources

    LRF offers a wide range of resources that address treatment options, the latest research advances, and ways to cope with all aspects of lymphoma. LRF also provides many educational activities, from in-person meetings to teleconferences and webcasts. For more information about any of these resources, visit the website at www.lymphoma.org or www.FocusOnCLL.org. You can also contact the Helpline at (800) 500-9976 or helpline@lymphoma.org.

    Webcasts/Podcasts

    Teleconferences

    View or order the following publications from our booklets/factsheets:

    Lymphoma Helpline

    Professional staff members are available to answer your questions and provide individual support to you and your loved ones. Contact our Helpline, available Monday through Friday from 8:00am - 5:00pm Pacific Standard Time (PST). Call (800) 500-9976 or e-mail helpline@lymphoma.org.