Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: Treatment Options

Treatment is based on the severity of associated symptoms as well as the rate of cancerAbnormal cell growth that cannot be controlled by the body's natural defenses. Cancerous cells can grow and eventually form tumors. growth. If patients show no or few symptoms, doctors may decide not to treat the disease right away, an approach referred to as “active surveillance” (also known as “watch and wait” or “watchful waiting”). With this strategy, patients’ overall health and disease are monitored through regular checkup visits and various evaluation procedures, such as laboratory and imaging tests. Active treatment is started if the patient begins to develop lymphoma-related symptoms or there are signs that the disease is progressing based on testing during follow-up visits. Studies have shown that patients with less advanced diseaseDisease that has spread to multiple locations. managed with an active surveillanceAn approach in which no immediate medical, surgical or radiation therapy is given. Patients are followed closely to make sure the cancer does not progress. approach have outcomes similar to those who are treated early in the course of the disease. However, patients with high-risk disease may need to start treatment right away.

There are many current first-line treatment options for CLL/SLL. The choice of treatment will depend on the stageThe extent of cancer in the body, including whether the disease has spread from the original site to other body parts. of the disease, the patient’s symptoms, the age and overall health of the patient, and the benefits versus side effects of treatment. Treatment choice may also vary depending on whether the patient’s lymphoma cells are missing parts of certain chromosomes (called deletions). One possible deletion in CLL is found  in the smaller arm of chromosome 17 (called a 17p deletion). While 17p is one of the most commonly occurring deletions, there are others that may affect treatment options.

Common drugs or drug combinations used as initial treatments for CLL/SLL include:

  • BR (bendamustine [Treanda] and rituximab [Rituxan])
  • CG (chlorambucil [Leukeran] and obinutuzumab [Gazyva])
  • FCR (fludarabine [Fludara], cyclophosphamide [Cytoxan], and rituximab)
  • FR (fludarabine and rituximab)
  • Ibrutinib (Imbruvica)
  • Ofatumumab (Arzerra) and chlorambucil
  • PCRA molecular test that can identify small amounts of genetic material. The test is done if looking for minimal residual disease. (pentostatin, cyclophosphamide, and rituximab)
  • Rituximab and chlorambucil
  • Rituximab and Hyaluronidase and Human (Rituxan Hycela)
  • Venetoclax (venclexta)

To learn about treatments under investigation for CLL/SLL, download the Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Fact Sheet.

See Also: