How CLL Treatment Is Changing
- New targeted therapies are rapidly expanding treatment options for chronic lymphocytic leukemia (CLL), giving patients access to medications that are more effective, better tolerated, and often available as pills rather than chemotherapy.
- Approved BTK inhibitors and the BCL-2 inhibitor venetoclax have improved CLL treatment. Investigational BTK degraders and new combinations are being studied to determine whether they are safe and can produce deeper or longer-lasting remissions.
- Treatment is increasingly personalized, with doctors tailoring therapy based on genetic features of the CLL, overall health, and patient preferences.
- “The available treatment now for CLL is very well tolerated. It achieves deep remissions and prolonged remission,” Dr. Omar Alkharabsheh, a medical oncologist with Orlando Health Cancer Institute, tells SurvivorNet.
“We have now different novel agents and different combinations, and those are improving patient outcomes,” Dr. Omar Alkharabsheh, a medical oncologist with Orlando Health Cancer Institute who specializes in blood cancers, tells SurvivorNet.
Read MoreNewer Targeted CLL Treatments
Many of the newer CLL treatments are designed to target specific proteins or pathways that CLL cells rely on to survive. One important group is Bruton’s tyrosine kinase (BTK) inhibitors. While earlier BTK inhibitors have already changed CLL treatment, researchers are now studying newer approaches that may work differently or overcome some of the limitations of earlier therapies. “We have the older covalent and the newer noncovalent BTK inhibitors, and also a BTK degrader. So the pipeline is busy, and it’s very exciting for patients,” Dr. Alkharabsheh says.Expert Resources for CLL Patients
- BTK Inhibitors: Finding The Right Fit For Chronic Lymphocytic Leukemia (CLL) Patients
- BTK Inhibitors for CLL Treatment: What Side Effects Can I Expect and How Do I Manage Them?
- Changing the Way CLL is Treated: What are BTK Inhibitors?
- BTK Inhibitors: Monitoring and Managing Side Effects During CLL Treatment
The development of these newer treatments is part of a broader effort to make CLL therapy more effective, better tolerated and increasingly personalized. Researchers are also studying combinations of targeted medications and new treatment approaches that may provide deeper and longer-lasting responses.
“The available treatment now for CLL is very well tolerated. It achieves deep remissions and prolonged remission,” Dr. Alkharabsheh adds.
Targeted therapies have replaced chemoimmunotherapy in most CLL treatment settings. They often avoid some chemotherapy-related toxicities but can still cause important, and sometimes serious, side effects.
Understanding Your Treatment Options
When treatment is needed for CLL, patients may receive targeted therapy as a pill, either by itself or in combination with an intravenous monoclonal antibody. Depending on the treatment selected, some therapies may also be given for a defined period of time rather than indefinitely.
“This is a type of chronic cancer. Not every patient requires treatment initially,” Dr. Alkharabsheh explains.
“When we initiate therapy, we no longer use chemotherapy. We use more of a newer treatment or targeted treatment. We can do a single agent or a pill form, or we can combine it with an intravenous monoclonal antibody, but we are no longer using chemotherapy for that. Those treatments are overall very well tolerated.”
Targeted therapy does not mean side-effect-free. Depending on the medication, BTK inhibitors may cause bleeding, infections, high blood pressure, or heart rhythm problems, while venetoclax can cause low blood counts, infections, and tumor lysis syndrome and therefore requires a gradual dose increase and close monitoring.
With more treatment options available, choosing the right therapy is not simply about selecting the newest medication. Doctors consider the characteristics of the CLL as well as the patient’s overall health, other medical conditions, lifestyle, and preferences.
Dr. Alkharabsheh explains, “We try to match the treatment combination to the patient’s preference first and their comorbidities.”
For patients, the expanding CLL treatment landscape means there are more factors to discuss with their hematologist or oncologist. Understanding whether treatment is needed now, what options are available, and how different therapies fit with individual health and personal preferences can help patients make informed decisions together with their care team.
Questions To Ask Your Doctor
- How will we determine if I should begin treatment for CLL?
- Do you recommend I start a targeted therapy such as a BTK inhibitor?
- What are the benefits and risks of starting on a BTK inhibitor?
- What potential side effects should I be aware of?
Learn more about SurvivorNet's rigorous medical review process.
