What You Should Know
- CLL treatment has advanced far beyond chemotherapy, with targeted therapies and immune‑based options now giving many patients longer control and, in some cases, long stretches without additional treatment.
- Immune‑driven approaches — including T‑cell engagers and CAR T‑cell therapy — are becoming increasingly important, especially for relapsed or treatment‑resistant CLL, though CAR T requires careful evaluation due to potential short‑term side effects.
- CLL remains a chronic disease, but the outlook is far more encouraging today, with expanding treatment choices focused on managing the disease over time, preserving quality of life, and finding the right therapy at the right moment — including clinical trials when appropriate.
“Chemotherapy, that stuff 10 years ago, again, it worked, but it came at a terrific price, and it was very disruptive. And today we have immunotherapy that can be delivered over a year with far less frequent visits, far less intravenous therapy, more oral therapy,” Dr. Gary Schiller, a professor in the Department of Medicine and the director of the Hematologic Malignancy Stem Cell Transplant Program at the David Giffen School of Medicine at UCLA, explains to SurvivorNet.
Read MoreExpert Resources for CLL Patients
- Changing the Way CLL is Treated: What are BTK Inhibitors?
- BTK Inhibitors: Monitoring and Managing Side Effects During CLL Treatment
- Chronic Lymphocytic Leukemia (CLL): How Can Pirtobrutinib Fit Into My Treatment Plan?
- BTK Inhibitors for CLL Treatment: What Side Effects Can I Expect and How Do I Manage Them?
- BTK Inhibitors Play An Important Role In CLL Treatment & Management
- BTK Inhibitor Combination Therapy for CLL: Weighing the Benefits and Trade-Offs
The Role CAR T-cell Therapy Plays In CLL Care
CAR T-cell therapy is another important advance. CAR T takes some of your own T cells, genetically modifies them in a laboratory so they can recognize CLL cells, and then returns them to your body to attack the cancer.In the United States, lisocabtagene maraleucel (Liso-cel; brand name Breyanzi) is now an approved option for adults with relapsed or refractory CLL/SLL after at least two prior lines of therapy, including a BTK inhibitor and a BCL-2 inhibitor.
WATCH: Understanding CAR T Treatment
CAR T is not appropriate for everyone as it requires careful evaluation and can cause significant short-term side effects, but it offers another potential option when CLL has become difficult to treat.
RELATED: Can You Afford the High Cost of CAR T-Cell Therapy?
CAR T-Cell Therapy Side Effects
Like all cancer treatments, CAR T-cell therapy can come with side effects, including:
- Cytokine Release Syndrome (CRS): This is a flu-like inflammatory surge that can cause fever, low blood pressure, or low oxygen levels. Up to 80% to 85% of patients experience some CRS; only 5-10% develop severe grades. Tocilizumab (an IL-6 blocker) and steroids can quickly settle most reactions.
- Immune-Effector Cell-Associated Neurotoxicity (ICANS): This condition can cause temporary confusion, word-finding trouble, lethargy, or seizures in rare cases. It affects about 35-45% of patients overall; severe events are uncommon and usually reversible. Treatment could involve close neuro checks, steroids, seizure medicines, and ICU care if needed.
- Low blood counts & infection risk: This can stem from the short chemo “primer” and immune reset. It is managed with growth-factor shots, antibiotics, and sometimes IV immunoglobulin. Most complications appear within two weeks of infusion, which is why centers monitor patients daily (in hospital or nearby lodging) during that window.
An Encouraging Outlook
CLL is still generally considered a chronic disease rather than one that can routinely be cured. However, the outlook is much more encouraging than it was in the past. Newer treatments have led to longer disease control and more treatment choices, and the field continues to move quickly.
For many patients, the goal is not simply to treat CLL once and be done. It is to manage the disease over time, preserve quality of life, and use the right treatment at the right time. As new therapies become available, treatment options are expected to continue to expand.
“The immediate future will be tailoring therapy based on the unique characteristics of the patient, both in terms of disease and who they are, where they are, what their age is, what their goals are, and so on.”
“But in the distant future, you wonder if immunotherapy might be able to, well, I don’t know if I want to use the word cure, but put the disease into such a long-term remission that it effectively is like a cure because there’s no visible sign of the disease until the patient dies of something else. And so I think that’s on the horizon,” Dr. Schiller tells SurvivorNet.
Your CLL team can help you understand not only what is available today, but also whether a clinical trial or emerging therapy may be worth considering in the future.
Questions to Ask Your Doctor
- Am I eligible for a CAR T-cell therapy?
- Which medication do you recommend? Why?
- Are there resources available to help with travel, lodging, and other costs?
- What are the risks vs. benefits of CAR T-cell therapy in my case?
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