Chronic lymphocytic leukemia (CLL) is a type of blood cancer that causes your bone marrow to make too many of a type of white blood cells called lymphocytes. Unlike other types of leukemia, it’s a slow-developing cancer that has a 5-year relative survival rate of 88%. (That means a person with CLL is 88% as likely to survive for 5 years as someone without CLL.)

Previously, chemotherapy, or “chemo,” was the standard treatment for CLL and many other cancers. While chemo is still an option for CLL, some people are opting for other treatment methods that may work better.

In fact, there are now more treatment options for CLL than ever, and research on new methods is ongoing. Learn more about CLL treatment options that do not involve chemo, including how each treatment works and any possible side effects to consider.

The term “chemotherapy” refers to a group of drugs used to treat many cancers. These drugs work by killing cancer cells and shrinking cancerous tumors. They are sometimes used in combination with other treatment methods, such as targeted therapies or surgery.

The downside to chemo is that it also damages healthy cells in your body. That’s why it’s known for causing negative side effects such as:

  • hair loss
  • nausea
  • vomiting
  • mouth sores
  • loss of taste and smell
  • fatigue
  • diarrhea

Additionally, chemo may be too aggressive of a treatment for CLL, depending on the stage of the cancer. According to the National Cancer Institute, chemo may be a treatment option for symptomatic, progressive, or recurring CLL.

Before starting chemotherapy treatment that will kill both cancerous and healthy cells in your body, your doctor might recommend watchful waiting for CLL. Watchful waiting consists of monitoring the signs and symptoms of your cancer and seeing a doctor for periodic testing.

There’s currently no cure for CLL, but since this cancer is slow-growing, your doctor may recommend watchful waiting in early CLL because aggressive treatments may not be necessary or helpful at those stages.

Targeted therapies have largely replaced chemotherapy for most people with CLL. These oral or intravenous medications work by targeting specific parts of cancer cells, thereby disabling them.

There are three main types of targeted therapies used in CLL cancer treatment:

  • BCL2 inhibitors: These targeted therapies work by blocking BCL2 proteins in leukemia cells. The process can kill CLL cells directly or help make other cancer treatments more effective. Venetoclax (Venclexta) is a BCL2 inhibitor used for CLL.
  • Monoclonal antibodies: By working with your immune system, these medications create antibodies that attach to cancer cells either to kill them or to prevent them from growing and spreading. Examples of monoclonal antibodies used for CLL treatment include obinutuzumab (Gazvaya), ofatumumab (Arzerra), and rituximab (Rituxan).
  • Tyrosine kinase inhibitors (TKIs): These therapies target certain enzymes in cancer cells to help stop excess white blood cell production. Examples of TKIs used in CLL include duvelisib (Copiktra), ibrutinib (Ibruvica), and zanubrutinib (Brukinsa).

While it’s considered less toxic than chemo, targeted therapy still carries risks of mild to serious side effects such as:

  • diarrhea
  • fatigue
  • mouth sores
  • dry skin or rashes
  • hair color loss
  • high blood pressure

The role of monoclonal antibodies

Monoclonal antibodies are types of targeted therapies. Unlike other targeted treatments, they may help kill cancer and prevent cancer progression by equipping your immune system with specific antibodies. In some cases, monoclonal antibodies may be used in addition to chemo.

In CLL treatment, monoclonal antibodies primarily target CD20, a type of protein located on B lymphocytes (the white blood cells where CLL develops).

Other types of monoclonal antibodies target CD52 proteins. These may be considered if previous treatments have not worked. CD52 proteins are located on T cells and CLL cells.

Also called radiotherapy, radiation therapy works by killing cancer cells with high energy X-rays. It may also be used to help treat a swollen spleen resulting from CLL.

Radiation therapy may be used for early-stage disease if there are bulky lymph nodes in one area of your body. These can be treated with radiation and may not need systemic treatment.

Possible side effects of radiation therapy include:

  • redness or burns at the treatment site
  • fatigue
  • diarrhea
  • nausea
  • vomiting
  • increased risk of infections

Sometimes surgery may be considered to remove tumors as part of a cancer treatment plan. For CLL, surgery is considered rare.

Unlike other common types of cancer, blood cancers such as CLL don’t form malignant tumors. Therefore, surgery for CLL is quite different from other types of cancer surgeries.

If you need surgery, a doctor may recommend a spleen removal (splenectomy).

A healthy spleen helps filter your blood and get rid of old blood cells. But because CLL creates too many lymphocytes, these cells may get backed up in your spleen and cause the organ to swell up. This can lead to further issues, such as destruction of red blood cells or platelets.

If your doctor recommends a splenectomy, keep in mind that this is a major surgery and there are risks involved, like excessive bleeding and infections. You’ll need several weeks to recover and may need to stay at the hospital for 1 week after your operation.

While there are several treatment options available for CLL, the choices are made on a case-by-case basis. Your doctor will recommend a treatment plan for your cancer based on:

  • the stage of your cancer (watchful waiting may be recommended for lower stages)
  • your age
  • individual concerns about side effects
  • your overall health, including other conditions you may have

CLL treatment plans are highly individual, and chemo side effects aren’t the only factors a doctor will consider.

Unlike other forms of leukemia, CLL progresses slowly. A doctor might recommend watchful waiting before starting cancer treatments. If treatment is necessary, they may recommend targeted therapies before other options.

If you or a loved one has recently received a diagnosis of CLL, consider talking with a doctor about all the treatment options.