Many people with CLL feel well and live for years with good health. Because some CLL patients have disease that progresses slowly and they may not have symptoms, immediate treatment may not be needed. With their doctors, these patients undergo a “watch and wait,” or “watchful waiting” period with frequent follow-up exams to follow the disease progression. By looking at the number of CLL cells and whether or not your lymph nodes, spleen, or liver are enlarged, your doctor will determine the optimal treatment plan for you.
While there is no cure for CLL, there are a number of treatments, which usually begin when the number of CLL cells greatly increases, the number of normal cells decreases, the lymph nodes become larger, and/or the spleen becomes larger.
Chemotherapy and monoclonal antibodies
Patients with faster-progressing disease are usually treated with oral or injected drug therapy, called chemotherapy, which frequently combines two or more drugs for maximum efficiency together.
Another option is the use of monoclonal antibody therapy, a treatment with substances that are made naturally in the body. Some of these antibodies kill cancer cells themselves while others are joined to chemotherapy drugs or radioactive molecules and directed at cancer cells.
Blood and Marrow Transplant (BMT)
Blood and bone marrow transplantation (BMT) is a treatment option for CLL patients. The two primary types of BMT are autologous (using your own previously harvested cells) and allogeneic (using cells from a donor). Both are preceded by high-dose chemotherapy and/or radiation, which destroy not only the cancerous cells in your body, but healthy cells as well. You'll be in the hospital during this time, to ensure that you are not exposed to possible infection. Then, during the transplant procedure, you’ll receive healthy cells which make their way to your bone marrow and start producing new blood cells.
Radiation therapy is not a common treatment for CLL, but may be used if you have a very large mass of lymphocytes that are blocking your gastrointestinal or urinary tract. This cancer treatment uses high-energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer, while internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The radiation method chosen for you depends on the exact type of the cancer being treated.
A splenectomy, which is surgery to remove the spleen, is used in a very small number of CLL patients when the spleen becomes filled with so many CLL cells that it causes discomfort or pressure.