Because the progression of chronic lymphocytic leukemia is slow, treatment may be delayed until symptoms begin, or tests indicate that the disease is worsening. Treating the disease earlier has shown not to be beneficial. Treatment for chronic lymphocytic leukemia usually includes chemotherapy or a bone marrow transplant. Chemotherapy drugs kill rapidly growing cancer cells. To perform a bone marrow transplant, chemotherapy is used to completely destroy the cells in the bone marrow first, and then bone marrow from a donor is transplanted into the patient's bone. Medications to control nausea are usually required during chemotherapy. The spleen may become enlarged as it removes abnormal cells from the bloodstream. In some cases, an enlarged spleen must be removed.
Treatment options for chronic lymphocytic leukemia include:
- Nonsteroidal anti-inflammatory medications for pain:
- Ibuprofen (Motrin, Advil, Nuprin, NeoProfen)
- Ketoprofen (Actron, Orudis, Oruvail)
- Naproxen (Anaprox, Naprosyn, Aleve)
- Narcotic pain medication:
- For moderate to severe pain
- For short term use only
- Medications for nausea and vomiting:
- Aprepitant (Emend)
- Dolasetron (Anzemet)
- Granisetron (Kytril)
- Metoclopramide (Reglan)
- Ondansetron (Zofran)
- Palonosetron (Aloxi)
- Prochlorperazine (Compazine, Compro)
- Chemotherapy for chronic lymphocytic leukemia:
- Pentostatin (Nipent)
- Chlorambucil (Leukeran)
- Fludarabine (Fludara)
- Alemtuzumab (Campath)
- Rituximab (Rituxan)
- Ofatumumab (Arzerra)
- Bone marrow transplantation for chronic lymphocytic leukemia
- Removal of the spleen
CLL Bone Marrow Transplant
Some patients with chronic lymphocytic leukemia may benefit from high-dose chemotherapy, followed by infusion of immature stem cells back into the bone marrow. This is called a bone marrow transplant, or stem cell transplant.
There are 3 main types of bone marrow transplantation that can be performed:
Autologous Bone Marrow Transplant
This method involves using the person's own bone marrow. Before the transplant and during remission, doctors will remove some of the bone marrow, and treat it with drugs to kill cancer cells. Normal marrow cells will be saved and frozen. After chemotherapy or radiation therapy the cancer-free bone marrow will be given back by IV infusion.
This involves donated marrow from an identical twin. It is ideal when the donor is available. In genetically identical twins, the body does not reject the transplanted marrow, nor does the marrow reject the body.
The donor is usually a parent, sibling or other person whose marrow type closely matches that of the patient. Using a large marrow database a donor can be found that is a close bone marrow match.
Close matching reduces the possibility of transplant rejection. Rejection occurs in 30% to 50% of bone marrow transplants.
Chemotherapy for Chronic Lymphocytic Leukemia
Chemotherapy drugs are a primary therapy for more advanced stages of chronic lymphocytic leukemia (Stages 1-IV). These drugs can directly destroy cancer cells in the body. Since chemotherapy is a systemic form of treatment, it goes all over the body. It not only kills cancer cells, but normal cells as well.
Most chemotherapy is delivered intravenously (injectable form), but a few can be taken orally. Drugs that need to get into the brain and spinal cord may need to be given with special catheters placed in these areas.
Chemotherapy may be given in cycles of treatment and recovery periods. The number of cycles is usually determined by a standard regimen (or protocol). The goal is to kill the rapidly-growing leukemia calls and restore the blood counts (and bone marrow) to normal. This is called remission.
During chemotherapy, patients often require treatment with medications to control nausea and vomiting and blood transfusions for anemia or low platelet counts. Sometimes antibiotics will be given to prevent bacterial infection.
Close monitoring of blood counts, liver and kidney function and the overall health of the patient is necessary during chemotherapy. Chemotherapy patients are usually at high risk for infection, bleeding and other complications due to the unwanted effects of the drugs on normal body cells.
The purpose of initial treatment is to achieve a remission. This is called remission induction. It is often followed by a period of lower-dose, maintenance chemotherapy. The desired result is a permanent remission, or cure.
Recurrences of leukemia may require more aggressive chemotherapy with a bone marrow transplant, or radiation therapy to affected areas.
CLL Questions For Doctor
The following are some important questions to ask before and after the treatment of chronic lymphocytic leukemia.
Questions to ask before treatment:
- What are my treatment options?
- Is surgery an option for me?
- What are the risks associated with treatment?
- Do I need to stay in the hospital?
- How long will I be in the hospital?
- What are the complications I should watch for?
- How long will I be on medication?
- What are the potential side effects of my medication?
- Does my medication interact with nonprescription medicines or supplements?
- Should I take my medication with food?
Questions to ask after treatment:
- Do I need to change my diet?
- Do I need to lose weight?
- Are there any medications or supplements I should avoid?
- When can I resume my normal activities?
- When can I return to work?
- What else can I do to reduce my risk for complications?
- How often will I need to see my doctor for checkups?
- What local support and other resources are available?
Continue to CLL Home Care
- Yee KW, O'Brien SM. Chronic lymphocytic leukemia: diagnosis and treatment. Mayo Clin Proc. 2006 Aug;81(8):1105-29.