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Chronic lymphocytic leukaemia (CLL) treatment and side effects

We're here for you if you want to talk

0808 2080 888

[email protected]

Chronic lymphocytic leukaemia (CLL) treatment types

In this section we talk about the specific treatments used when treatment is needed for CLL.

Page updated 28 July 2021

You might also want to read our general information about how blood cancer treatment is planned and managing your treatment.

We also have some important information on staying safe if you’ve got blood cancer, covering things like risk of infection and vaccinations.

Treatment for CLL

Although in most cases CLL isn’t a curable condition, many people with the disease will have a good quality of life. You might not need treatment at first – especially if you don’t have any symptoms. If you feel well, your team might just see you for regular check-ups. Your specialist will tell you when they think you might need to start treatment and discuss your options with you. See our information on treatment planning for CLL.

Active treatment for CLL can involve medication (either chemotherapy or non-chemotherapy drugs) and antibodies. Some people may have a stem cell transplant, but this is rare. A very small number of people might need more intensive treatment earlier on if their CLL is progressing more quickly, or if they were diagnosed at a late stage.

Treatment during the coronavirus pandemic

While the coronavirus pandemic continues, your healthcare team will do their best to protect you. This might mean changes to how you're treated or where you're treated. Speak to your healthcare team if you have any questions about your treatment options.

Read our information about coronavirus and your blood cancer treatment.

Chemo-immunotherapy and other drugs

If you need to start treatment and your general health is good, your healthcare team will probably suggest you are given anti-leukaemia drugs (chemotherapy). Drugs called monoclonal antibodies are usually given as well. These are artificial antibodies which can bind to and kill specific cells. Treatment using a combination of chemotherapy drugs and antibodies is called chemo-immunotherapy.

In recent years, there have been major developments in the treatment of CLL. Targeted drugs are increasingly used to treat CLL. These work by blocking the signals that make cancer cells grow, and can often be given without chemotherapy.

Some drugs are taken as tablets (orally). Others are given through a drip into one of your veins. This is called an infusion, or intravenous infusion.

FCR is a combination of chemotherapy drugs called fludarabine and cyclophosphamide, and a monoclonal antibody called rituximab. It is a common first treatment for CLL and is a type of chemo-immunotherapy.

FCR is given in treatment ‘cycles’. Each cycle is 28 days long. You’ll normally have treatment once a day for the first five days, and then have a break of 23 days with no treatment. This is repeated up to six times - each period of treatment and rest is called a cycle.

Fludarabine and cyclophosphamide are taken as tablets. Rituximab is given as an infusion (drip).

If you can't have FCR treatment, you may be offered bendamustine, sometimes also with rituximab. Bendamustine is a chemotherapy drug and rituximab is a monoclonal antibody. When given together, they are often called BR, and are another example of chemo-immunotherapy.

Bendamustine and rituximab are both given through a drip. You will often have the treatment on two consecutive days, and then have a few weeks off. This is repeated up to six times.

Acalabrutinib is a targeted drug (a chemotherapy-free treatment). It is a tablet you take twice a day. It can be used:

In England

  • As a first treatment, if you have CLL with the genetic characteristics known as a 17p deletion or TP53 mutation
  • As a first treatment, if you have CLL with no 17p deletion or TP53 mutation, but FCR or bendamustine with rituximab aren't suitable for you.

In Scotland

  • As a first treatment, if you have CLL with the genetic characteristics known as a 17p deletion or TP53 mutation, , and chemo-immunotherapy isn't suitable for you.
  • As a first treatment, if you have CLL with no 17p deletion or TP53 mutation, and chemo-immunotherapy isn't suitable for you.

Acalabrutinib can also be used if you've had previous treatment.

Acalabrutinib is approved for use in England and Scotland.

Wales and Northern Ireland often approve the same drugs as England and Scotland but we are waiting to see a public confirmation or news about this.

Venetoclax and obinutuzumab is a chemotherapy-free drug combination that has been approved for use in England, Scotland, Wales and Northern Ireland.

If you have genetic characteristics known as a 17p deletion or TP53 mutation, you may be offered venetoclax and obinutuzumab as a first treatment.

If you don't have a 17p deletion or TP53 mutation, you may be offered venetoclax and obinutuzumab as a first treatment if FCR or bendamustine and rituximab aren't suitable for you. Even if FCR and bendamustine are suitable, you may be offered venetoclax and obinutuzumab as a first treatment under the Cancer Drugs Fund in England.

Venetoclax is taken as a tablet, and obinutuzumab is given as an infusion (drip). The treatment is given for a 12-month period.

You may be offered ibrutinib as a first treatment if you have certain genetic characteristics known as a 17p deletion or TP53 mutation. Ibrutinib is an inhibitor drug that blocks signals within cells that are important for their survival.

Ibrutinib can also be used as a second treatment if your first treatment hasn’t worked, or the CLL has returned after a responding to treatment at first.

Ibrutinib is taken as tablets (orally).

If FCR and bendamustine with rituximab aren't suitable for you, you may be offered chlorambucil and obinutuzumab as a first treatment (this is another chemo-immunotherapy treatment).

Chlorambucil is a chemotherapy tablet. Obinutuzumab is a monoclonal antibody and is given as a drip. Your healthcare team will tell you how many courses you’ll have, and when.

If you have certain genetic characteristics known as a 17p deletion or TP53 mutation, and you can't have other treatments, then you may be offered idelalisib and rituximab.

Idelalisib is an inhibitor drug that blocks some of the proteins inside cancerous blood cells that encourage the cancer to grow. It is taken as a tablet. Rituximab is a monoclonal antibody that you are given by drip.

Idelalisib can also be used to treat some people whose leukaemia has not responded to other treatments.

Recent research has shown that you may be at greater risk of serious and fatal infections if you’re treated with idelalisib. To manage these risks, you will be given antibiotics throughout your treatment as protection (this is called prophylaxis). All drug treatments carry some risk. Your healthcare team will carefully weigh the risks against the benefits when deciding which treatment to offer you.

Venetoclax is a drug which blocks the growth of CLL cells and promotes cell death.

It can be used in combination with the monoclonal antibody rituximab for people who have had at least one previous treatment.

Venetoxlax is given as tablets and rituximab is given as a drip.

Venetoclax can also be used under the Cancer Drugs Fund for some other people - those who have a 17p deletion or TP53 mutation where an inhibitor drug like ibrutinib or idelalisib is unsuitable, those whose disease has progressed after an inhibitor drug like ibrutinib or idelalisib, and those who don't have a 17p deletion or TP53 mutation but disease has progressed after both chemo-immunotherapy and an inhibitor drug.

In some cases you may be offered treatment with the monoclonal antibody rituximab alongside other drugs. Rituximab is usually given through a drip.

This monoclonal antibody isn’t usually given anymore as it’s now an unlicensed drug and only available through a compassionate access programme. However, it may be used if your cytogenetic blood tests show that fludarabine isn’t likely to work for you.

Alemtuzumab is usually given on is own, in cycles. Your healthcare team will tell you exact timings. It’s usually given as an injection just beneath the skin (subcutaneous). You might be given steroids at the same time.

Radiotherapy

Most people with CLL don’t have radiotherapy, but if your spleen is swollen and uncomfortable, local radiation treatment to shrink it might be helpful.

On very rare occasions patients might have an operation to remove their spleen (a splenectomy). You might then get more infections, but your healthcare team will give you advice on how to decrease the chances of this happening. This might include long-term antibiotic treatment.

Stem cell transplant

A stem cell transplant is what used to be called a bone marrow transplant. It aims to give patients healthy stem cells, which then produce normal blood cells.

It isn’t a suitable treatment for most CLL patients. This is because the risks of a transplant aren’t justified for patients with a slowly developing disease like CLL. For some patients – especially those whose disease is progressing more quickly – a transplant may provide a cure, but the risks of a transplant need to be carefully weighed against the potential of a cure.

People with CLL who need a stem cell transplant will be offered one that uses stem cells from a healthy donor (an allogeneic/allograft transplant).

Stem cell transplants using your own cells (autologous/autograft) are no longer used to treat people with CLL as they do not successfully stop the CLL from coming back.

Find out more about stem cell transplants.

We're here for you if you want to talk

0808 2080 888

[email protected]