Leukemia

Chronic Lymphocytic Leukemia

Signs and Symptoms
Diagnosis
Treatment

Treatment

Most patients with early-stage chronic lymphocytic leukemia (CLL) do not need any treatment when the disease is first diagnosed. These patients will live 10 to 15 years on average, and early treatment offers no advantage. Treatment should start when the patient either has an advanced form of the disease or has an intermediate stage with significant symptoms, very enlarged lymph nodes or a rapid increase in the lymphocyte count (doubling in less than 12 months).

Chemotherapy

The most common treatment for CLL is the chemotherapy drug fludarabine. This is given intravenously (through an IV) five days a week once a month for four to six months. Although the schedule for fludarabine is rather inconvenient, it only causes modest side effects, such as fatigue. Most patients will have a good response to this treatment and remain in remission without further treatment for two to three years. Chlorambucil, an oral chemotherapy drug, may be used instead of fludarabine, especially for elderly or frail patients.

Investigational Therapies

There are a number of new treatments currently being tested, including:

• The use of other chemotherapy drugs, such as cyclophos-phamide and Cytoxan, in combination with fludarabine to see whether this increases the effectiveness of treatment

• The addition of antibody treatment with rituxirnab (Rituxan)

• The use of the experimental antibody Campath IH, which appears to be another effective form of treatment

In addition, allogeneic stem cell transplantation, also called bone marrow transplantation, can be used to potentially cure CLL. However, this therapy is only used to treat the occasional young patient with aggressive CLL, since most patients with CLL live so long that the risk of transplant can seldom be justified.

Reviewed by health care specialists at UCSF Medical Center.
Last updated August 1, 2007