Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: Treatment Options
Treatment is based on the severity of associated symptoms as well as the rate of cancer growth. If patients show no or few symptoms, doctors may decide not to treat the disease right away, an approach referred to as “active surveillance” (also known as “watch and wait” or “watchful waiting”). With this strategy, patients’ overall health and disease are monitored through regular checkup visits and various evaluation procedures, such as laboratory and imaging tests. Active treatment is started if the patient begins to develop lymphoma-related symptoms or there are signs that the disease is progressing based on testing during follow-up visits. Studies have shown that patients with less advanced disease managed with an active surveillance approach have outcomes similar to those who are treated early in the course of the disease. However, patients with high-risk disease may need to start treatment right away.
There are many current first-line treatment options for CLL/SLL. The choice of treatment will depend on the stage of the disease, the patient’s symptoms, the age and overall health of the patient, and the benefits versus side effects of treatment. Treatment choice may also vary depending on whether the patient’s lymphoma cells are missing parts of certain chromosomes (called deletions). One possible deletion in CLL is found in the smaller arm of chromosome 17 (called a 17p deletion). While 17p is one of the most commonly occurring deletions, there are others that may affect treatment options.
Common drugs or drug combinations used as initial treatments for CLL/SLL include:
- Acalabrutinib (Calquence)
- BR (bendamustine [Treanda] and rituximab [Rituxan])
- CG (chlorambucil [Leukeran] and obinutuzumab [Gazyva])
- FCR (fludarabine [Fludara], cyclophosphamide [Cytoxan], and rituximab)
- FR (fludarabine and rituximab)
- Ibrutinib (Imbruvica)
- Ibrutinib-Obinutuzumab (Imbruvica-Gazyva)
- Ibrutinib-rituximab (Imbruvica-Rituxan)
- Ofatumumab (Arzerra) and chlorambucil
- PCR (pentostatin, cyclophosphamide, and rituximab)
- Rituximab and chlorambucil
- Rituximab and Hyaluronidase and Human (Rituxan Hycela)
- Venetoclax (venclexta)
- Zanubrutinib (Brukinsa)
To learn about treatments under investigation for CLL/SLL, download the Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Fact Sheet.