Chronic lymphocytic leukaemia (CLL) treatment and side effects
Chronic lymphocytic leukaemia (CLL) treatment first and second line
The first treatment you have after being diagnosed with CLL is called first-line treatment. If you go on to have further treatment, this is called second-line treatment.
The aim of first-line treatment is to reduce the number of CLL cells, to get control of the disease.
If there is a clinical trial (study) available, your consultant might recommend that you consider this. Clinical trials are done for several reasons, including to look for new treatment options and to improve existing treatments. Taking part in a clinical trial has many advantages, such as the opportunity to have the newest available treatment which will only rarely be available outside of the trial. You’ll also be very closely monitored and have detailed follow up.
Taking part in a clinical trial does come with uncertainties, and you may prefer not to take part in one. If you don’t want to be in a trial, or there isn’t a suitable trial available, you’ll be offered the best treatment available at that time which is suitable for your individual condition. We have more information on CLL treatment types.
Find out more about clinical trials in the UK on this NHS website.
Most patients respond well to treatment, but it’s unlikely to cure you. Unfortunately, even if you respond well to the first treatment, there’s a strong chance that your disease will come back (recur), although this might not be for several years. If you’ve been in remission for a long time after having FCR or another first-line treatment, it’s likely that the same treatment will work again, so repeating a treatment is a potential option in some circumstances.
If your CLL comes back soon after your first treatment, there are a number of options. Your team might recommend that you take part in a clinical trial or offer you different treatments. These may include ibrutinib, idelalisib with rituximab, or venetoclax with rituxumab, depending on which treatment you had initially.
Rarely, younger patients with high-risk disease may be offered a stem cell transplant.
A small number of people don’t respond well to initial treatment. This is called refractory CLL. If this happens to you and your lymph nodes or spleen are swollen, then you might be given high doses of steroids. This will usually cause them to shrink and then other treatments can be considered.