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Chronic Lymphocytic Leukemia (CLL) Treatment

At Penn, we aren't just thinking about what treatments are available today for people with chronic lymphocytic leukemia (CLL); we are looking ahead at what's to come in the future.

With clinical trials, novel agents, and newer and better diagnostic and genetic testing tools, we are improving treatment options for people with CLL and improving diagnostics to customize and individualize treatment plans.

The investigational therapy program in CLL includes research on targeted "chemotherapy-free" modalities that use monoclonal antibodies, monoclonal antibody combinations, radio immunotherapy, therapeutic vaccination, and trials of agents targeting intracellular pathways, as well as immunotherapy research that utilizes the body's own immune system to attack CLL.

Treatment for Chronic Lymphocytic Leukemia

Your treatment for CLL greatly depends on the symptoms it is causing, your ongoing medical conditions and analysis of your specific prognostic factors.

Our CLL team including hematologists and medical oncologists, is a large multidisciplinary team whose approach to cancer and blood disorders is to treat the entire individual — not just the disease.

A hematologist is a physician who specializes in blood diseases and disorders in blood-forming organs. Penn hematologists diagnose and treat patients with blood disorders such as hemophilia, leukemia, platelet disorders and anemia.

A medical oncologist is a physician who specializes in the diagnosis and treatment of cancer. Penn oncologists work closely with radiation and surgical oncologists to treat cancer patients with medical therapies such as chemotherapy, hormone therapy, immunotherapy and bone marrow and stem cell transplants.

Together with you, your team of hematologist-oncologists and other sub-specialists at Penn will help determine what treatments are right for you based on the stage and classification of your disease.

Below are treatments for CLL.

Bone Marrow and Stem Cell Transplant

About Our Bone Marrow and Stem Cell Program

Our bone marrow and stem cell transplant team are made up of the same clinicians responsible for your overall treatment and care.

Other ways our bone marrow and stem cell transplant program are unique:

  • Our program is backed by a premier bone marrow and stem cell transplant research program that continues to make history in the development of new treatments through basic science research and clinical trials.
  • We have nationally recognized experts available to provide information, care and support throughout the transplant process.
  • Our bone marrow and stem cell transplant program is one of the oldest and largest in the country, and has pioneered new therapies to treat blood cancers.
  • We have one of the few hematologic malignancy (leukemia, lymphoma and myeloma) research programs in the country that is approved and funded by the National Cancer Institute.
  • We have a dedicated hospital unit that is completely equipped to support transplant patients with experienced nurses who understand the medical and personal issues patients face during transplant.
  • We serve as medical advisors for area outreach organizations such as the Multiple Myeloma Networking Group and the Leukemia and Lymphoma Society.

Learn more about bone marrow and stem cell transplants at the Abramson Cancer Center.

Chemotherapy

Chemotherapy uses drugs to attack cancer cells, slowing or stopping their ability to grow and multiply.

Chemotherapy is usually given:

  • Orally: taking pills or capsules by mouth
  • Intravenously (IV): injecting medication into a vein
  • Intramuscularly (IM): injecting medication into a muscle
  • Subcutaneously: injecting medication under the skin

Chemotherapy is not a "one-size-fits-all" cancer treatment. The wide range of cancer-fighting drugs attack different types of cancer cells at varying stages of cell development. Penn medical oncologists are experts at determining which drug or combination of drugs will be the most effective in treating your CLL

For a comprehensive list of most commonly used chemotherapy agents, please visit OncoLink.

Clinical Trials for CLL

Cancer specialists at the Abramson Cancer Center are part of the Eastern Cooperative Oncology Group (ECOG), one of the largest clinical cancer research organizations in the nation.

With the ECOG, cancer specialists from Penn are designing clinical trials to test novel therapies, new agents, or new treatment standards for people with leukemia.

Advantages of Clinical Trials

Being in a clinical trial offers you the opportunity to be treated with treatments, medications or agents that are not otherwise available.

It also gives you the opportunity to be treated by, and have your case reviewed by experts who are directly involved with the design of the treatment.

Through clinical trials:

  • Diagnosing cancer has become more precise
  • Radiation and surgical techniques have advanced
  • Medications are more successful
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes
  • Strategies to address the late effects of cancer and its treatment have been developed to improve the quality of life

Learn more about clinical trials, frequently asked questions about clinical trials, and available clinical trials at the Abramson Cancer Center.

Complementary and Integrative Therapies

In addition to standard treatments and clinical trials, you may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy.

These therapies do not have curative intent, and are designed to complement standard treatments — not take their place.

Integrative Oncology Services

Our integrative oncology services can supplement traditional cancer treatments such as chemotherapy.

While conventional medicine plays a critical role in eradicating cancer, integrative oncology services offer you and your family ways to minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

We are knowledgeable of and support complementary cancer treatments.

Our cancer teams work with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

Our integrative supportive services include:

Immunotherapy and Vaccine Therapy

Penn Medicine is a pioneer in using patients' own immune systems to fight cancer.

Immunotherapy is designed to repair, stimulate, or enhance the immune system's responses. The body's immune system helps to prevent disease, but it can also play a role in preventing cancer from developing or spreading.

The goal of immunotherapy is to enhance the body's natural defenses and its ability to fight cancer.

Immunotherapy may have fewer side effects than conventional cancer treatments because it uses the body's own immune system to:

  • Target specific cancer cells, thereby potentially avoiding damage to normal cells
  • Make cancer cells easier for the immune system to recognize and destroy
  • Prevent or slow tumor growth and spread of cancer cells

T-Cell Immunotherapy for Leukemia

Researchers at the Abramson Cancer Center have molecularly-engineered T-cells from patients with chronic lymphocytic leukemia and re-introduced them with remarkable success.

In July 2014, the U.S. Food and Drug Administration granted CTL019 its Breakthrough Therapy designation for the treatment of relapsed and refractory adult and pediatric ALL, a step which is intended to expedite the development and review of new medicines that treat serious or life-threatening conditions, if a therapy has demonstrated substantial advantages over available treatments. CTL019 is the first personalized cellular therapy to receive the designation.

How T-Cell Immunotherapy for Leukemia Works

Here is how T-Cell immunotherapy for leukemia works:

  • A patient's own immune cells (T-cells) are removed from the blood and genetically modified or reprogrammed in the laboratory.
  • This modification or reprogramming allows them to potentially target and kill their own malignant cells. The modified cells (CTL019 cells) are then grown in the laboratory and re-infused into the patient.
  • When the patient's own T-cells recognize and bind to the malignant cell, they have the ability to become activated and kill it.

To learn more about this exciting therapy, call 855-216-0098, or email a trial navigator.

Vaccine Therapy

Vaccine therapy is a type of immunotherapy that uses vaccines to teach the body's immune system to attack and destroy cancer cells. Cancer vaccines are intended to delay or stop cancer cell growth, shrink tumors, prevent cancer from coming back or eliminate cancer cells that have not been killed by other forms of treatment.

Cancer treatment vaccines are sometimes made with cells from the patient's own tumor, which are modified in the lab and then given back to the patient to stop, destroy or delay the growth of the cancer.

Targeted Molecular Therapy

Targeted molecular therapy, at Penn Medicine's Abramson Cancer Center, offers a type of personalized medical therapy designed to treat cancer by interrupting unique molecular abnormalities that drive cancer growth.

Targeted therapies are drugs that are designed to interfere with a specific biochemical pathway that is central to the development, growth and spread of that particular cancer.

Because not every cancer develops in the same way in every person, targeted molecular therapy is personalized to the individual. In some cancers, the molecular targets are known. But in other cancers, these targets are still being identified. The same types of cancer may have different molecular targets. Identifying the molecular targets in any given patient's cancer requires working closely with pathologists to carefully analyze the cancer pathology.

Targeted cancer therapies such as targeted molecular therapy may give medical oncologists a better way to customize cancer treatment.

Advantages of molecularly targeted therapy include:

  • Potentially less harm to normal cells
  • Potentially fewer side effects
  • Improved effectiveness
  • Improved quality of life

At the Abramson Cancer Center, we have experience and expertise delivering targeted molecular therapy, and are leading research to find newer and more effective ways to treat cancer with molecular targeted therapies.

We are studying the use of targeted therapies for use alone, in combination with other CLL targeted therapies, and in combination with other cancer treatments, such as chemotherapy and radiation.

Read more about Targeted Molecular Therapy.

Watchful Waiting

If your CLL is diagnosed at an early stage and you do not have any symptoms, we may recommend an active surveillance approach.

Active surveillance requires you to be monitored closely by your physician. This "watch and wait" approach allows you to avoid the side effects from cancer treatment since your disease is stable and not showing symptoms.

People with CLL can live for years with a watchful waiting approach. Up to one third of CLL patients may never require therapy over their lifetime. If you do begin to have symptoms, your doctor may recommend you start treatment.