CLL treatments

Chemotherapy medications have been a mainstay treatment of cancer for many years and are administered either orally or intravenously (through a drip). They work by entering the bloodstream to stop or slow the division of cancerous and healthy cells throughout the body.

These are cancer treatments that have been developed to only target the specific genes and proteins on or within cells that are helping the cancer grow and survive, meaning that they have less effect on healthy cells. Simply put, targeted treatments work to kill the cancerous cell, leaving the healthy cells to thrive.

Most people with CLL who require treatment are treated either with an inhibitor, which targets proteins found on or within the surface of cancer cells, or with chemo-immunotherapy, where a monoclonal antibody treatment is provided in combination with chemotherapy.

Monoclonal antibodies treat CLL by targeting proteins on white blood cells called B-lymphocytes (B-cells). This makes the B-cells die. Monoclonal antibodies are usually given with chemotherapy and are ordinarily administered intravenously (via a drip).

Bruton’s Tyrosine Kinase inhibitors (BTKi) target the proteins on the surface of CLL cells called B-cell receptors, which are responsible for the growth of CLL. If these receptors are shut down, the cell dies. These drugs block kinases, which are proteins in cells that normally relay signals (such as telling the cell to grow). BTKi’s are usually taken daily as tablets or capsules for as long as they continue to work.

Malignant CLL cells continue to grow due to the overproduction of a protein called BCL2. Blocking this protein helps to kill the cells causing CLL, which is what BCL2 inhibitors do. BCL2 inhibitors are usually taken daily as tablets for as long as they continue to work.

A stem cell or bone marrow transplant is a treatment where donated cells called stem cells are transplanted into your body, so you start to produce healthy white blood cells. It is a procedure that is more rare and is an intensive type of treatment that's not suitable for everyone.

Radiotherapy will not be an option for most people with CLL, as it is a treatment that delivers targeted beams of radiation to a specific area of cancer in the body. It tends to be used if the spleen or specific cluster of lymph nodes become swollen or symptomatic. Radiotherapy is a painless procedure, but it can often result in side effects such as redness at the area, fatigue, nausea and vomiting.

A splenectomy (the removal of the spleen) may be considered as a cause of action for some patients on rare occasions. It usually becomes an option if the spleen has enlarged and starts causing complications, and where other treatment methods have failed to reduce its size. People can live full lives without a spleen, although there is a higher risk of infection.

You may be given blood transfusions as part of a supportive care treatment if you experience severe anaemia or problems with bleeding and bruising, to provide more red blood cells and platelets (clotting cells).

These are usually given to patients who are immunocompromised (have a weakened immune system) and are susceptible to infections (which CLL patients are due to a lowered white blood cell count) and are generally administered in conjunction with chemotherapy which can lower the immune system further.

Granulocyte-colony stimulating factor (G-CSF) is a type of growth factor protein which helps to create more white blood cells. It is normally given when a specific type of immune cells (neutrophils) are below the normal range in your blood. It can be used in conjunction with:

• chemotherapy to stimulate the bone marrow into creating neutrophils (white blood cells that help fight infection)
• before a stem cell transplant to encourage the release of stem cells into the blood which can then be collected and used in for the transplant.