Treatment for CLL
Chronic lymphocytic leukaemia (CLL) usually develops slowly without many symptoms. People diagnosed with CLL often don’t need treatment straightaway, and some people never require treatment. This may be surprising to hear, but research has shown that for people without symptoms, starting treatment immediately is not any better than delaying treatment until it is needed. Delaying treatment also means you won’t have to go through the side effects of treatment until necessary.
For a small number of people (5–10%), CLL turns into a form of non-Hodgkin lymphoma called diffuse large B-cell lymphoma. This is known as Richter’s transformation. Diffuse large B-cell lymphoma is a faster-growing type of lymphoma that usually needs to be treated straightaway. Your doctor will discuss the available treatments.
Learn more about:
- Active monitoring
- Treatment options
- Making treatment decisions
- Chemotherapy and targeted therapy
- Other treatments
- Palliative treatment
Active monitoring is when your doctor recommends no treatment but monitors your health with regular check-ups and blood tests. This is sometimes called “careful monitoring” or “watch and wait”.
Chronic lymphocytic leukaemia (CLL) can lower your resistance to infection, so you may be more likely to catch infections such as shingles and the flu. It is important to talk to your doctor about symptoms of infections to watch out for, and to get treatment as soon as possible if you have these symptoms.
Your doctor may also recommend that you and the other people in your household have an annual flu vaccination. (You should not have the shingles vaccination as it contains a live virus, which can be dangerous to people with lowered immunity.)
You will also be advised to have regular skin checks, as people with CLL are more likely to develop skin cancer.
Living with untreated chronic leukaemia may make you feel anxious. It may help to talk to your medical team or contact the hospital social worker or psychologist for support. You can also speak to other people who have CLL.
Your doctor may decide to begin active treatment for CLL if:
- you have symptoms such as fevers, sweats or weight loss
- the number of red blood cells and platelets falls
- your lymph nodes become very swollen and/or put pressure on important internal structures, such as in your neck or kidneys
- your spleen becomes enlarged
- the number of lymphocytes in your blood doubles in less than six months.
The treatment you are offered will depend on the features of the leukaemia, and your age and general health.
Treatment options start with first-line treatment, which aims to reduce the number of CLL cells and get the disease under control. Although most people respond well to treatment, it’s likely that the disease will come back (recur) in some people, and they will have further treatment known as second-line treatment.
Sometimes CLL doesn’t respond to treatment but the disease remains stable. This is known as refractory or resistant CLL. Your specialist will talk to you about other treatments you can consider. You may also want to join a clinical trial.
Podcast: Making Treatment Decisions
Download a PDF booklet on this topic.
Dr Kate Melville, Haematology Staff Specialist, Calvary Mater Newcastle, and Conjoint Lecturer, The University of Newcastle; Karl Jobburn, Clinical Nurse Consultant, Haematology, Liverpool Hospital; Patricia Masters, Consumer; Karen Robinson, 13 11 20 Consultant, Cancer Council NSW; Dr Emma Verner, Staff Specialist, Haematology, and Medical Director, Bone Marrow Transplant and Apheresis Unit, Concord Hospital, and Clinical Senior Lecturer, The University of Sydney.
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