Chronic lymphocytic leukemia (CLL) is most often treated with chemotherapy, which may be done with a single drug or a combination of drugs. Radiation and transfusions are sometimes used, though the disease is only treated in its latter stages. Each patient's preferences and overall health are taken into account when treatment with CLL chemotherapy is being planned.
CLL chemotherapy is given in the form of pills or through a vein. The method in which chemotherapy is given depends on the side effects the patient experiences. Side effects of chemotherapy can include low blood cell counts, fatigue and frequent infections. Nausea and hair loss also are side effects some patients experience.
Nucleoside analogues are the most common CLL chemotherapy drugs. Of these, fludarabine is the drug used most often as of 2011. Monoclonal antibodies also are used to treat CLL and alemtuzumab is the most common of these. A combination of these drugs seems to work better than many chemotherapeutic drugs used alone, especially for those who previously have been treated for CLL. Infections can occur more often with certain kinds of combination treatments than with treatments that use a single medication.
CLL chemotherapy is not used if a patient is in the early stages of the disease; instead, the patient is monitored until he or she begins to show symptoms. This monitoring usually is done using blood tests that are conducted every few months. Chromosome tests are performed that detect molecular markers. If these markers are present, the patient is considered to be at high risk and treatment is started. Early treatment may be started in patients who are not considered high risk if certain symptoms occur, such as recurring infections, low blood counts or weight loss.
If CLL chemotherapy is not effective, then radiation and transfusions may be used. Radiation generally is used to treat lymph nodes that are swollen and painful. Transfusions of blood and platelets are reserved for younger patients who have high risk or advanced CLL. A transfusion is the only treatment that can offer a cure as of 2011.
The preferences of the patient and his or her overall health are taken into careful consideration when a CLL chemotherapy treatment plan is being designed. This allows patients to have more control over their treatment and encourages communication between doctors and patients. Some patients may prefer using a single drug or a combination of drugs. The way the treatment is administered also can be influenced by the patient's preferences.