Skip to Main Content
Treatment Cancer

Chronic Lymphocytic Leukemia

Most patients with early-stage chronic lymphocytic leukemia 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).


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 causes only 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.

The remission rate and length of remission are increased by adding a monoclonal antibody, Rituximab — also used to treat lymphoma — to fludarabine. The most aggressive regimen, fludarabine plus cyclophosphamide plus Rituximab (FCR), has the highest response rate (close to 100 percent), but at the expense of a high infection risk. A new chemotherapy drug, bendamustine, was recently approved for CLL; the patient receives two doses intravenously every month. Another agent, lenalidomide (Revlimid), which is FDA-approved for the treatment of multiple myeloma and certain types of myelodysplastic syndrome, has activity in CLL and is an oral medication.

Chlorambucil, an oral chemotherapy drug, may be used instead of fludarabine, especially for elderly or frail patients.

Stem Cell Transplantation

Allogeneic stem cell transplantation, also called bone and marrow transplantation (BMT), 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.

Investigational Therapies

UCSF is dedicated to improving outcomes for CLL patients through the use of investigational therapies and clinical research trials. Clinical trials currently available to UCSF patients include Flavopiridol for CLL cases that don't respond to standard treatment. Flavopiridol kills CLL so quickly that blood salt and acid-base abnormalities arise, potentially causing kidney failure. The first cycle of Flavopiridol is given in the intensive care unit with kidney hemodialysis immediately available. Also available are national trials adding biologic agents, such as lenalidomide, to standard accepted CLL therapies.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

Recommended reading

Matched Unrelated Donor Transplantation

Bone marrow transplantation can be performed using one's own bone marrow or by using another person's bone marrow. Learn more here.

Hematology and BMT Resource Guide

This hematology and bone marrow transplant (BMT) resource guide provides information about diseases and treatments, employment, insurance and more.

Self-Care for Caregivers

Caregiver fatigue can be brought on by the physical and emotional demands of caring for a loved one with a serious illness. Learn tips to combat caregiver fatigue here.

Communicating with Your Doctor

The relationship with a doctor is a very personal one, built on communication and trust. In choosing a doctor, the "chemistry" between the two of you must work.

Coping with Chemotherapy

Each person experiences side effects from chemotherapy differently, and different chemotherapy drugs cause different side effects. Learn more here.

Delegation to Help with Fatigue

Fatigue caused by cancer treatment can make it difficult to accomplish even the smallest of tasks. Learn how task delegation can help with this fatigue.

Diet for Cancer Treatment Side Effects

Nausea is a common side effect of chemotherapy and radiation therapy. Find practical tips and suggested foods to help with nausea here.

FAQ: Cancer Pathology Tissue Slides

Find frequently asked questions regarding cancer pathology tissue slides, such as how to obtain the slides and what to do with them once you do.

FAQ: Cancer Radiology Scans and Reports

Learn the difference between a radiology report and radiology films or scans as well as why your doctor may be requesting these scans and more.

Managing Your Treatment

Living with or caring for someone with cancer can be a full-time job. Here are some tips to reduce stress and help navigate the disease more effectively.

Nutrition and Coping with Cancer Symptoms

Side effects of cancer treatment may affect your eating pattern, requiring new ways to get the calories, protein and nutrients that you need. Learn more.

Questions to Ask Your Doctor

Your time with the doctor is limited, thus it's helpful to prepare for the visit in advance by prioritizing the questions that are important to you. Learn more.

Resources for End of Life

The UCSF Cancer Resource Center has a list of bereavement support groups, counselors, hospice and others dealing with end-of-life issues. Learn more.

Tips for Conserving Your Energy

Cancer and cancer therapy can be accompanied by feelings of extreme fatigue. To help you deal with this fatigue, follow these easy tips help conserve energy.

Using a Medical Calendar and Symptom Log

Take time at the end of each day or each week to reflect back on the symptoms you've had. You can use a calendar to track your symptoms. Learn more here.

Seeking care at UCSF Health

Expand Map