2 of 2 NCCN QUICK GUIDE tm Chronic Lymphocytic Leukemia, 2018 PAT-N-1004-0917 Besides clinical trials, what are my first treatment options? For CLL without del(17p) or TP53 mutation Options for older or younger sick people who have CLL consist of both chemotherapy and targeted therapy drugs. 38 Options for younger, healthy people with CLL may include the standard of care FCR ( f ludarabine, c yclophosphamide, r ituximab). Other options inlcude chemotherapy and targeted therapy drugs. 40 Options for older or younger sick people with CLL may include obinutuzumab plus chlorambucil. Next in line is ibrutinib. Other options inlcude chemotherapy and targeted therapy drugs. 42 Treatment for CLL with del(17p) or TP53 mutation A clinical trial is advised. If you can’t join a clinical trial, ibrutinib is the standard of care. Other options include HDMP ( h igh- d ose m ethyl p rednisolone with rituximab, obinutuzumab, and alemtuzumab with or without rituximab. 44 What is Richter’s transformation or CLL with progression? What are the treatment options? Richter’s transformation is when CLL becomes a more aggressive lymphoma such as DLBCL ( d iffuse l arge B - c ell l ymphoma) or Hodgkin lymphoma. CLL can also progress and show other changes but not be Richter’s transformation. Tests are done to learn more about the transformation or progression of disease. 45 A clinical trial is advised. Other options include combinations of chemotherapy and immunotherapy drugs. 47 Do I need supportive care? People with CLL are likely to get infections and other illnesses. Supportive care includes treatment for the health problems caused by CLL and cancer treatment. 49 How do I decide between options? Ask your doctors many questions. Also, you could get a 2 nd opinion, attend support groups, and compare the benefits and risks of different options. 54 NCCN Guidelines for Patients ® Page Number Ü NCCN.org - for Clinicians | NCCN.org/patients - for Patients DONATENOW nccnfoundation.org The NCCN QUICK GUIDE tm series and NCCN Guidelines for Patients ® are supported by charitable donations made to the NCCN Foundation ® . For more details and the full library of patient and caregiver resources, visit NCCN.org/patients.