Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) are cancers that affect a type of white blood cells known as B lymphocytes. Combined, they represent the most common type of leukemia in adults in the western world. Both CLL and SLL are generally slow-growing cancers, and symptoms may not appear for a long time. However, when those symptoms appear, they can significantly affect the patient’s quality of life and necessitate treatment.
The good news is, advancements in medical research over the past few decades have brought forth more effective and less intrusive treatments for CLL and SLL. First, it is important to note that not everyone with CLL or SLL will require immediate treatment. A "watch and wait" approach is typically employed when the disease is in its early stages and not causing any symptoms.
Once treatment becomes necessary, several options are available depending on the patient's overall health, age, and the stage and progression rate of the cancer.
Chemotherapy is one traditional method which involves the use of chemicals to kill cancer cells. A common regimen is fludarabine, cyclophosphamide, and rituximab (FCR), which is highly effective, but has significant side effects and is not suitable for everyone. Another regimen is bendamustine plus rituximab (BR). This might be an option if FCR is considered too intense.
In the past decade, targeted therapies have emerged and changed the treatment landscape for CLL and SLL. These therapies attack specific abnormalities in the cancer cells. Imbruvica (ibrutinib) and Calquence (acalabrutinib) are examples of targeted drugs called Bruton’s tyrosine kinase (BTK) inhibitors, which block a specific protein that helps lymphoma cells survive and grow. Another drug, Venclexta (venetoclax), targets a different protein (BCL-2) that helps lymphoma cells to stay alive.
Another more recent approach to treating CLL and SLL is immunotherapy, employing the body’s own immune system to fight the cancer. Monoclonal antibodies like rituximab, obinutuzumab, and alemtuzumab can be used alone or combined with chemotherapy, while CAR-T therapy involves genetically modifying the patient’s T cells to target and kill the leukemia cells.
Advancements in the treatment of CLL and SLL have offered several options that can potentially provide a better quality of life for patients. Careful and personalized consideration of these methods can afford a patient continued remission and better survival rates. It is essential that patients consult with their healthcare providers to fully understand these options and choose the treatment course that best suits their individual circumstances. The future for CLL and SLL treatments seems bright, with ongoing research continually yielding promising results.