Chronic Lymphocytic Leukemia is the most common form of leukemia in Western countries. Although currently incurable, there have been significant advances in research efforts of CLL treatments in recent years, and this post will explore the current CLL treatment options.

Disease classification

There are two different systems used for staging CLL, the Rai system (mostly used in the US) and the Binet system (used more widely in Europe). The Binet system classifies the stage of CLL by the number of affected lymphoid tissue groups and includes three stages:

• Stage A corresponds to an increase in the number of B lymphocytes, without other blood abnormalities, with the absence or very limited presence of lymph nodes
• Stage B corresponds to an increase in the number of B lymphocytes, without other blood abnormalities, and associated with the presence of lymph nodes in several ganglionic areas
• Stage C corresponds to an increase in the number of B lymphocytes associated with other blood abnormalities: anemia (decrease in hemoglobin levels) and/or a decrease in the number of blood platelets

In more than 60% of patients diagnosed with CLL the prognosis is relatively good. Patients are monitored without requiring immediate treatment and often live with the disease for several years (the 5-year survival rate for patients with CLL is around 4/5) and early treatment has not proved to help increase life expectancy of CLL patients. When the disease presents more aggressively however, treatment is required immediately.

CLL Treatment Options

The choice of CLL treatment is currently based on the stage of the cancer, the presence of genetic abnormalities and their nature, prognosis factors such as the presence of deletions in chromosomes 17 or 11, treatment response and presence of symptoms including weight loss or fever.

CLL patients are treated with chemotherapy, immunotherapy, targeted therapy as well as stem cell transplants. Globally, across all lines of treatment, Ibrutinib has the largest market share; it is prescribed to almost one third of CLL patients. Other leading products on the market are Venetoclax mono, Rituximab mono, Ofatumumab Chlorambucil, Idelalisib, BR / RBENDA and FCR.

Including all lines of therapy almost 50% of all treated CLL patients are treated with BCRIs and over 10% receive FCR among treated patients. Immunotherapies are frequently used as the disease largely affects older patients with comorbidities that can restrict the use of more traditional cytotoxic agents. Monoclonal antibodies (artificial immune system antibodies) are designed to attach to specific targets, helping a patient’s immune system to destroy cancer cells.

Stem cell transplants allow doctors to use higher doses of chemo, sometimes along with radiation therapy, to treat CLL.

When patients respond well to the first line of CLL treatment, the same chemotherapy will usually be used for relapsed and refractory patients. If the disease becomes resistant to the chemotherapy, BCRIs are used in high proportion.