NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

11 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2019 1  CLL basics Treatment types stages labeled A, B, and C. The stages are based on your physical exam and blood tests. The Binet system may be helpful but isn’t used in this book to decide starting treatment. Treatment types This section briefly describes treatments for CLL. Not everyone receives the same treatment. Your doctor will tailor treatment to you based on tests described in Part 2 . Treatment options based on features of the cancer and your health are listed in Part 3 . Targeted therapy Targeted therapy is a class of drugs. It impedes the growth process that is specific to cancer cells. It harms normal cells less than chemotherapy. Kinase inhibitors Within cells, kinases are part of many chemical pathways, some of which start cell growth. They change the action of proteins by attaching phosphates to them. Kinase inhibitors stop growth signals by blocking the transfer of phosphates. This lowers the number of new cells being made. Kinase inhibitors are used to stop kinases within cancer cells. Ibrutinib and acalabrutinib stop a kinase called BTK ( B ruton’s t yrosine k inase). Idelalisib targets one form of PI3K ( p hospho i nositide 3 - k inase) called delta. Duvelisib targets two forms of PI3K— delta and gamma. BCL-2 inhibitors BCL-2 is a protein inside of B cells that helps prevent cell death. In CLL, BCL-2 may build up and stop the cancer cells from dying. Venetoclax is a BCL-2 inhibitor that allows the cancer cells to self-destruct. Antibody treatment Antibodies are Y-shaped proteins of the immune system. They help your body detect germs and other threats. Monoclonal antibodies can be made in a lab to treat certain types of cancer. CD20 and CD52 antibodies CD20 antibodies attach to a surface protein on cells called CD20. Likewise, CD52 antibodies attach to CD52. Both treat CLL by marking cells for destruction by your immune system. They may directly kill cells, too. CD20 antibodies include obinutuzumab, ofatumumab, and rituximab. Alemtuzumab is a CD52 antibody. PD-1 antibodies PD-1 antibodies are also called immune checkpoint inhibitors. Nivolumab and pembrolizumab are PD-1 antibodies. PD-1 antibodies attach to immune cells and allow your immune system to destroy the cancer cells. More research is needed to learn how well they treat CLL that has transformed into a lymphoma. Lymphomas are cancers of white blood cells in the lymph system. The key to managing fear is in making informed decisions. Stay positive, make a plan for yourself and go forward one step at a time.” – Ted Leukemia Survivor “