Treatment of Chronic Lymphocytic Leukaemia (CLL)
Chemotherapy is the main treatment used for this condition. Treatment may be delayed in people with this condition until symptoms develop this is called ‘watchful waiting’. The following treatment is likely to be given if the disease is not advanced at diagnosis:
- Chlorambucil – this is a tablet form of chemotherapy which is often given by itself and it is given intermittently over at least 6 months. It has few side effects.
- Fludarabine – has similar side effects to Chlorambucil it can be given as a tablet or injection.
These drugs when given over a period of time often put the leukaemia into remission. If Chlorambucil does not manage it, this treatment may continue with a course of biological therapy such as Rituximab or Alemtuzumab.
Younger people may be offered more aggressive treatment than Chlorambucil or Fludarabine and this might include:
- Fludarabine and Cyclophosphamide
- Fludarabine and Cyclophosphamide and a biological therapy treatment such as Rituximab or Alemtuzumab (Campath) and or a steroid drug such as methylprednisolone.
Cyclophosphamide is usually given over 6 cycles (24 weeks) in combination with Fludarabine.
Rarely stem cell or bone marrow transplant treatment may be used for CLL.
Most people will have chemotherapy as their main treatment but some people may have other treatments as well.
- Surgery –Some people may have their spleen removed ( a ‘splenectomy’) because it is enlarged or painful – this is usually done as an open operation – the recovery time is up to 6 weeks.
- Radiotherapy – rarely radiotherapy may be used to treat uncomfortably swollen lymph nodes or an uncomfortably swollen spleen. Treatment is likely to be low dose and given over a week or so. The treatment improves symptoms with minimal side effects.
- Steroid drugs including prednisolone, methylprednisolone and dexamethasone. These drugs are used in short bursts during chemotherapy treatment. In general side effects are minimal. However if used for prolonged periods the following side effects are very common – significant weight gain, osteoporosis and diabetes mellitus. Rarer side effects include psychiatric problems ranging from depression and anxiety to full blown psychotic episodes.
Recurrent Chronic Lymphocytic Leukaemia
People whose leukaemia has come back or has transformed into high grade leukaemia – this may be called ‘Richter’s Syndrome’ will usually go on to have second line treatment. This is likely to include a combination of chemotherapy drugs and a common example of this is CHOP.
CHOP (Cyclophosphamide, doxorubicin, vincristine and prednisolone)
Chemotherapy regimes will usually be given over 6-8 three week cycles (18-24 weeks in total).
If disease returns again it can often be kept under control for some time with further chemotherapy. As a person has more treatments over time they are likely to collect disabling effects related to both the disease and its treatment.
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Amended February 2009
