Weighing the Benefits of CLL Treatment Options
- Chronic lymphocytic leukemia (CLL) treatment generally follows one of two approaches: time-limited combination therapy or continuous treatment with a daily BTK inhibitor (a type of targeted therapy).
- Time-limited therapy may require more appointments, blood tests and monitoring upfront, but treatment typically stops after about one year to a year and a half.
- Continuous therapy may be more convenient because it involves taking a daily pill, but patients can remain on treatment indefinitely and may experience cumulative side effects.
- Age, overall health, disease characteristics, treatment logistics and personal preferences can all influence which approach is best.
- “I strongly encourage time-limited therapies for the majority of my patients because it allows [a] prolonged treatment-free period,” says Dr. Alexey Danilov, a leading hematologist and researcher at City of Hope in Los Angeles.
“When it’s time to talk about treatment and decide what the treatment is, there are many factors that go into the decision of how and when to do this,” Dr. Alexey Danilov, a leading CLL researcher with City of Hope in Los Angeles, tells SurvivorNet.
Read MoreTime-Limited v. Continuous Treatment
According to Dr. Danilov, there are two basic approaches to treating CLL today. “One is a time-limited approach with a combination of drugs, and the other one is a continuous approach with BTK inhibitors … where you take a pill for life,” he says.The two treatment approaches for CLL include:
- Time-limited therapy: A combination of medications is given for a defined period, often about one year to a year and a half. Time-limited therapy may require more appointments, blood tests, and monitoring upfront. Once the regimen is completed, however, treatment stops and patients may have an extended treatment-free period.
- Continuous therapy: A BTK inhibitor (targeted treatment) is taken every day for as long as it controls the disease and remains tolerable. These targeted drugs block a protein that helps CLL cells grow and survive.
“The time-limited approach would be a combination of drugs where you have to do more work upfront, but then you’re able to stop treatment after, say, a year, year and a half,” Dr. Danilov says.
Patients still need follow-up appointments after treatment so their doctors can continue to monitor their CLL.
Expert Resources for CLL Patients
- A Decade of Progress: New Targeted Treatments Are Redefining What’s Possible For People With CLL
- BTK Inhibitors: Finding The Right Fit For Chronic Lymphocytic Leukemia (CLL) Patients
- CLL Treatment: What Side Effects Can I Expect From BTK Inhibitors?
- Chronic Lymphocytic Leukemia (CLL): How Can Jaypirca (Pirtobrutinib) Fit Into My Treatment Plan?
- How Targeted Therapies Have Transformed CLL Treatment
Continuous treatment typically involves taking a BTK inhibitor every day. Dr. Danilov compares the approach to managing another chronic condition.
“The continuous approach would be taking a pill to control your condition, CLL, just like we do with blood pressure or diabetes,” he says. “But of course, then there is a risk of cumulative side effects down the road.”
Lifestyle and Convenience Matter
Some patients prefer the simplicity of taking a daily pill instead of completing a more involved combination regimen.
“Some people strongly prefer just taking another pill and not dealing with maybe the cumbersomeness of coming to the clinic for any sort of blood checks for this time-limited therapy,” Dr. Danilov says.
Others prefer completing treatment and having a break from daily medication.
“Others really like the idea of having an off-treatment period and not having to deal with the pill every day,” he adds. “So it really becomes a very individualized decision.”
Why Age Can Affect the Decision
Dr. Danilov particularly encourages younger patients to consider time-limited therapy. Someone who begins treatment in their 60s and may live another 20 or 25 years could otherwise spend decades taking continuous medication.
“It’s a pretty long time to be on a pill,” he says. “I strongly encourage time-limited therapies for the majority of my patients because it allows [a] prolonged treatment-free period.”
Still, the best choice depends on the individual. Patients and their doctors should weigh the disease’s characteristics, potential side effects, treatment logistics, and personal preferences before deciding.
Questions To Ask Your Doctor
- Do you recommend time-limited or continuous therapy in my case?
- How often will I need to be monitored on time-limited therapy?
- What are the potential side effects for each approach?
- How often would I be monitored after time-limited therapy?
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