NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

12 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2019 1  CLL basics Review Chemotherapy Chemotherapy works by damaging cancer cells. As a result, cancer cells cannot make new cells. Chemotherapy can also cause cells to destroy themselves. Chemotherapy is often used with antibody treatment to treat CLL. This combined treatment is called chemoimmunotherapy. There are many types of chemotherapy. If your health is fairly good, your treatment may include a purine analogue. Purine analogues include fludarabine, cladribine, and pentostatin. If your health is poor, you may get chemotherapy drugs called alkylating agents. Bendamustine , cyclophosphamide, and chlorambucil are alkylating agents. Other types of chemotherapy may be used if CLL transforms into lymphoma. Immunomodulators Immunomodulators are drugs that modify some parts of the immune system. Lenalidomide is an immunomodulator that is often used to treat a cancer called multiple myeloma. For CLL, it is sometimes used to maintain the good results of the main treatment. Stem cell transplant A stem cell transplant replaces unhealthy stem cells with healthy ones. An allogeneic transplant uses healthy stem cells from a donor. Testing is needed to confirm if the donor and you are a good match. An allogeneic transplant is an intense treatment so not everyone can get it. You’ll first receive treatment to kill your bone marrow and most CLL cells. Next, you’ll receive the donor cells. These cells will form new, healthy marrow. They will also attack cancer cells that weren’t killed by prior treatment. Visit the websites listed in Part 4 for more information on transplants. Clinical trial One treatment choice may be whether to join a clinical trial. Joining a clinical trial is strongly supported. NCCN believes that you will receive the best management in a clinical trial. A clinical trial is a type of research that studies a test or treatment in people. It gives people access to health care that otherwise couldn’t usually be received. Ask your treatment team if there is an open clinical trial that you can join. Review † † White blood cells are a part of your body’s immune system. Lymphocytes are a type of white blood cell and include natural killer cells, B cells, and T cells. † † Leukemias are cancers of blood cells. CLL is one type of leukemia that causes too many abnormal B cells. † † Your blood needs to be tested to diagnose CLL. Doctors look for very high numbers of abnormal B cells. They also look for proteins that are common and uncommon to CLL cells. † † The Rai system is used to stage CLL and decide when to begin treatment. † † Common treatments for CLL are targeted therapy, antibody treatment, and chemotherapy. † † Clinical trials give people access to new tests and treatments that they otherwise couldn’t have received.

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