Treatment

Treatment for chronic lymphocytic leukaemia (CLL)largely depends on what stage the condition is at when it's diagnosed.

You may just need to be monitored at firstif it's caught early on. Chemotherapy is the main treatment if it's more advanced.

Treatment can often help keep CLL under control for manyyears.

Itmay go away after treatment initially (known as remission), but will usually come back (relapse) a few months or years later and may need to be treated again.

This page covers:

Stages of CLL

Monitoring early-stage CLL

Chemotherapy for more advanced CLL

Stem cell or bone marrow transplants

Other treatments for CLL

Deciding against treatment

Clinical trials for CLL

Stages of CLL

Doctors use"stages" to describe how far CLL has developed and help them determine when it needs to be treated.

There are three main stages of CLL:

• stage A you have enlarged lymphglands in fewer than three areas (such as your neck, armpit or groin) and a high white blood cell count
• stage B you have enlarged lymph glands in three or more areas and a high white blood cell count
• stage C you have enlarged lymphglands or an enlarged spleen, a high white blood cell count, and a low red blood cell or platelet count

Stage B and C CLL are usually treated straight away. Stage A generally only needs to be treated if it's getting worse quickly or starting to cause symptoms.

Monitoring early-stage CLL

Treatment may not be needed if you don't have any symptoms when you're diagnosed with CLL.

This is because:

• CLLoften develops very slowly and may not cause symptoms formany years
• there's no benefit in starting treatment early
• treatment can cause significant side effects

In these cases, you will normally just need regular visits to your doctor and Blood tests to monitor the condition.

Treatment with chemotherapy will usually only be recommended if you develop symptoms, or tests show that the condition is getting worse.

Chemotherapy for more advanced CLL

Many people with CLL will eventually need to have chemotherapy. This involves taking medication to keep the cancer under control.

There are a number of different medicines for CLL, but most people will take three main medications in treatment cycles lasting 28 days.

These medicines are:

• fludarabine usually taken as a tabletfor three to five days at the start of each treatment cycle
• cyclophosphamide alsousually taken as a tabletfor three to five days at the start of each treatment cycle
• rituximab giveninto a vein over the course ofa few hours (intravenous infusion) at thestart of each treatment cycle

Fludarabine and cyclophosphamide can usually be taken at home. Rituximab is given in hospital, and sometimes you may need to stay in hospital overnight.

A number of different medicines can also be tried if you can't have these medicines, you've tried them but they didn't work, or your CLL has come back after treatment.

These include bendamustine, chlorambucil, ibrutinib, idelalisib, obinutuzumab, ofatumumab and prednisolone (a steroid medication ).

Side effects of treatment

The medicines used to treat CLL can cause some significant side effects, including:

• persistent tiredness
• feeling sick
• an increased risk of infections
• easy bruising or bleeding
• anaemia shortness of breath , weakness and pale skin
• hair loss or thinning
• an irregular heartbeat
• an allergic reaction

Most side effects will pass once treatment stops. Let your care team know if you experience any side effects, asthere are some treatments that can help.

There's also a risk of serious problems after the transplant, such as graft versus host disease. This is wherethe transplanted cells attack the other cells in your body.

Deciding against treatment

As many of the treatments for CLL can have unpleasant side effects that may affect your quality of life, you may decide against having a particular type of treatment.

This is entirely your decision and your treatment team will respect any decision you make.

You won't be rushed into deciding about your treatment, and before making a decision you can talk to your doctor, partner, family and friends.

Pain relief and nursing care will still be available as and when you need it.