Table of ContentsView AllTable of ContentsWhen to Treat or NotEarly CLLProgressive CLLTreatment When Progressive
Table of ContentsView All
View All
Table of Contents
When to Treat or Not
Early CLL
Progressive CLL
Treatment When Progressive
Chronic lymphocytic leukemia(CLL) is a type of cancer that affects the blood and bone marrow. It can progress slowly and may not cause many symptoms. Although it is treatable, it’s not considered to be curable.
In the early stages, CLL often doesn’t require treatment immediately, as studies have shown that early treatment doesn’t increase survival from the disease.However, as CLL advances, treatment may become necessary.
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CLL: When to Treat and Not Treat Cancer
The decision to treatchronic lymphocytic leukemiadepends on several factors, including thestage of the disease, the presence ofsymptoms, and the person’s overall health.
A watchful waiting approach is often used when CLL isdiagnosedin the early stages, meaning close monitoring of the disease without treating it until symptoms appear or worsen. At the diagnostic stage, the person with CLL often doesn’t have any symptoms, and the side effects and risks of treatment can outweigh the benefits.
Studies have also shown that even in those with more high-risk disease, starting treatment earlier doesn’t increase theiroverall survival.
Treatment can become necessary when symptoms develop or the disease begins to progress. Symptoms can include:
Additionally, treatment is considered if there is a rapid increase in white blood cell count or a decrease in other blood levels, such as red blood cells andplatelets. Treatment, whether watchful waiting or active treatment, is tailored to each person.
Understanding Watchful Waiting
Watchful waiting, also known as active surveillance, is commonly used in most people with CLL.During watchful waiting, blood work and checkups are typically done every three months to assess for any disease progression.
By waiting to start treatment, those with CLL can be spared the potential side effects and complications of therapies that aren’t necessary at their current stage. Although most people will eventually require treatment, about 30% of people with CLL can continue with watchful waiting and never require treatment.
Watchful Waiting and Mental HealthWhile watchful waiting for managing CLL is focused on monitoring the disease, it’s important to address the impact this approach may have on mental health. Some people may experience anticipatory anxiety about CLL progressing and have fear and worry about their future health.The stress of living with a chronic illness can lead to depression and cause a sense of helplessness.Connecting with support groups, therapists, and counselors can help cope with this chronic illness. The healthcare team managing CLL should address these concerns and help people achieve peace of mind during a watchful waiting period.
Watchful Waiting and Mental Health
While watchful waiting for managing CLL is focused on monitoring the disease, it’s important to address the impact this approach may have on mental health. Some people may experience anticipatory anxiety about CLL progressing and have fear and worry about their future health.The stress of living with a chronic illness can lead to depression and cause a sense of helplessness.Connecting with support groups, therapists, and counselors can help cope with this chronic illness. The healthcare team managing CLL should address these concerns and help people achieve peace of mind during a watchful waiting period.
While watchful waiting for managing CLL is focused on monitoring the disease, it’s important to address the impact this approach may have on mental health. Some people may experience anticipatory anxiety about CLL progressing and have fear and worry about their future health.
The stress of living with a chronic illness can lead to depression and cause a sense of helplessness.
Connecting with support groups, therapists, and counselors can help cope with this chronic illness. The healthcare team managing CLL should address these concerns and help people achieve peace of mind during a watchful waiting period.
Biomarkers and Symptoms Warranting Treatment
Biomarkers (an objective measurement of something happening in the body) and symptoms that indicate a more active disease pattern guide treatment initiation for CLL.
The International Workshop on CLL has published guidelines. At least one of the following must be present to determine active CLL.
Additionally, certain genetic markers, such as deletion 17p or mutation in the TP53 gene, suggest a more aggressive disease course and may require treatment sooner.
What to Do With Early CLL Without Treatment
For those with CLL who are not under active treatment, there may not be any specific steps to take to prevent thediseasefrom progressing. However, improving overall health is important. Some factors to enhance a healthy lifestyle include:
Factors such as an individual’s genetic makeup and molecular characteristics of CLL cannot be controlled.
Progressive CLL Symptoms and Stages
As CLL advances, a range of symptoms may be present. These symptoms may include:
If someone with CLL begins to experience these or other concerning symptoms, they should contact their healthcare provider for further evaluation.
Treatment to Manage Progressive CLL
If CLL progresses to the point where treatment is indicated, a variety of treatment options are available. The goal of treatment is to manage the disease and reduce symptoms. Exactly which treatment will be ordered depends on many factors and is individualized to the person receiving them.
Treatment options can include:
Targeted therapies include Bruton tyrosine kinase (BTK) inhibitors and antiapoptotic protein B cell lymphoma 2 (BCL2) inhibitors. These medications target cancer cells with specific mutations. They are more likely to spare healthy cells from being damaged than systemic treatments like chemotherapy. Examples of targeted therapy include Calquence (acalabrutinib), Imbruvica (ibrutinib), and Venclexta (venetoclax).
Clinical trials are an option for people with CLL. Many trials examine new treatment molecules or novel combinations of treatments.
Summary
CLL is a slowly progressing cancer affecting the blood and bone marrow. It often doesn’t cause symptoms in its early stages. It is not considered curable. Early-stage CLL usually doesn’t require immediate treatment, as starting therapy early doesn’t improve survival rates.
However, as CLL advances and symptoms worsen, treatment becomes necessary. Treatment decisions are based on disease stage, symptoms, and overall health. Maintaining a healthy lifestyle and regular checkups are crucial for managing early-stage CLL.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bewarder M, Stilgenbauer S, Thurner L, Kaddu-Mulindwa D.Current treatment options in CLL.Cancers. 2021;13(10):2468. doi:10.3390/cancers13102468Herling CD, Cymbalista F, Groß-Ophoff-Müller C, et al.Early treatment with FCR versus watch and wait in patients with stage Binet A high-risk chronic lymphocytic leukemia (Cll): a randomized phase 3 trial.Leukemia. 2020;34(8):2038-2050. doi:10.1038/s41375-020-0747-7Kyrou D, Stavrogianni K, Koulierakis G, et al.The looming cancer: a qualitative study on the experience of living with chronic lymphocytic leukemia (CLL) before the initiation of treatment. Mahla RS, ed.European Journal of Cancer Care. 2024;2024:1-12. doi:10.1155/2024/4034801Hallek M, Cheson BD, Catovsky D, et al.iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL.Blood. 2018;131(25):2745-2760. doi:10.1182/blood-2017-09-806398American Cancer Society.Signs and symptoms of chronic lymphocytic leukemia.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bewarder M, Stilgenbauer S, Thurner L, Kaddu-Mulindwa D.Current treatment options in CLL.Cancers. 2021;13(10):2468. doi:10.3390/cancers13102468Herling CD, Cymbalista F, Groß-Ophoff-Müller C, et al.Early treatment with FCR versus watch and wait in patients with stage Binet A high-risk chronic lymphocytic leukemia (Cll): a randomized phase 3 trial.Leukemia. 2020;34(8):2038-2050. doi:10.1038/s41375-020-0747-7Kyrou D, Stavrogianni K, Koulierakis G, et al.The looming cancer: a qualitative study on the experience of living with chronic lymphocytic leukemia (CLL) before the initiation of treatment. Mahla RS, ed.European Journal of Cancer Care. 2024;2024:1-12. doi:10.1155/2024/4034801Hallek M, Cheson BD, Catovsky D, et al.iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL.Blood. 2018;131(25):2745-2760. doi:10.1182/blood-2017-09-806398American Cancer Society.Signs and symptoms of chronic lymphocytic leukemia.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Bewarder M, Stilgenbauer S, Thurner L, Kaddu-Mulindwa D.Current treatment options in CLL.Cancers. 2021;13(10):2468. doi:10.3390/cancers13102468Herling CD, Cymbalista F, Groß-Ophoff-Müller C, et al.Early treatment with FCR versus watch and wait in patients with stage Binet A high-risk chronic lymphocytic leukemia (Cll): a randomized phase 3 trial.Leukemia. 2020;34(8):2038-2050. doi:10.1038/s41375-020-0747-7Kyrou D, Stavrogianni K, Koulierakis G, et al.The looming cancer: a qualitative study on the experience of living with chronic lymphocytic leukemia (CLL) before the initiation of treatment. Mahla RS, ed.European Journal of Cancer Care. 2024;2024:1-12. doi:10.1155/2024/4034801Hallek M, Cheson BD, Catovsky D, et al.iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL.Blood. 2018;131(25):2745-2760. doi:10.1182/blood-2017-09-806398American Cancer Society.Signs and symptoms of chronic lymphocytic leukemia.
Bewarder M, Stilgenbauer S, Thurner L, Kaddu-Mulindwa D.Current treatment options in CLL.Cancers. 2021;13(10):2468. doi:10.3390/cancers13102468
Herling CD, Cymbalista F, Groß-Ophoff-Müller C, et al.Early treatment with FCR versus watch and wait in patients with stage Binet A high-risk chronic lymphocytic leukemia (Cll): a randomized phase 3 trial.Leukemia. 2020;34(8):2038-2050. doi:10.1038/s41375-020-0747-7
Kyrou D, Stavrogianni K, Koulierakis G, et al.The looming cancer: a qualitative study on the experience of living with chronic lymphocytic leukemia (CLL) before the initiation of treatment. Mahla RS, ed.European Journal of Cancer Care. 2024;2024:1-12. doi:10.1155/2024/4034801
Hallek M, Cheson BD, Catovsky D, et al.iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL.Blood. 2018;131(25):2745-2760. doi:10.1182/blood-2017-09-806398
American Cancer Society.Signs and symptoms of chronic lymphocytic leukemia.
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