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Leukemia - Chronic Lymphocytic - CLL - Introduction

Approved by the Cancer.Net Editorial Board, 10/2017

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Chronic Lymphocytic Leukemia. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

About leukemia

Leukemia is a cancer of the blood. Leukemia begins when healthy blood cells change and grow out of control. Chronic lymphocytic leukemia (CLL) is a cancer of the lymphocytes. Lymphocytes are a type of white blood cell involved in the body’s immune system. In some people with CLL, the disease grows and progresses slowly. This means it may take years for symptoms to appear or for treatment to be needed. In fact, some patients may never need treatment for their CLL. In other patients, the disease grows more quickly and needs treatment sooner.

About lymphocytes

Lymphocytes circulate in the bloodstream and are made in 4 places in the body:

  • Lymph nodes, which are the tiny, bean-shaped organs that fight infection

  • Spleen, which also filters the blood

  • Thymus, an organ under the breast bone

  • Bone marrow, the spongy, red tissue in the inner part of the large and flat bones

There are 3 different types of lymphocytes:

  • T cells, which fight infection by triggering other cells in the immune system and by destroying infected cells

  • B cells, which make antibodies

  • Natural killer (NK) cells, which fight microbes and cancer cells

About CLL

In people with CLL, the abnormal cells crowd other types of cells in the bone marrow. This crowding prevents the production of the healthy blood cells, including:

  • Red blood cells that carry oxygen

  • Other types of white blood cells, such as neutrophils or granulocytes that fight infection

  • Platelets, which are needed for blood to clot

This means that people with CLL may have anemia from low levels of red blood cells and more infections because they do not have enough white blood cells. They may also bruise or bleed more easily because of a low level of platelets.

Most often, CLL is diagnosed when too many abnormal lymphocytes are found in the blood, also known as lymphocytosis. However, the same disease can occur when the abnormal lymphocytes are mostly in the lymph nodes but not in the blood. This is called small lymphocytic lymphoma, but it behaves very similarly to CLL.

Types of CLL

There are 2 general types of CLL based on whether the disease affects B cells or T cells. It is important for doctors to find out whether the disease is caused by the overgrowth of T cells or B cells.

However, even between these 2 types of CLL, there are several subtypes that differ at the genetic level. This means that the disease may act differently based on the genetic subtype. For example, one person with the B-cell type may have the disease act differently than another person with the B-cell type.

Learn more about other, rare types of chronic T-cell leukemia and types of B-cell leukemia.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with CLL and general survival rates. Use the menu to choose a different section to read in this guide.

Leukemia - Chronic Lymphocytic - CLL - Statistics

Approved by the Cancer.Net Editorial Board, 10/2017

ON THIS PAGE: You will find information about the number of people who are diagnosed with CLL each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

CLL is the most common type of leukemia in adults, accounting for 37% of cases. This year, an estimated 20,940 people of all ages (12,990 men and 7,950 women) in the United States will be diagnosed with CLL. CLL is more common in older adults. The average age of people diagnosed with CLL is approximately 70. CLL is uncommon in people under age 40 and very rare in children.

It is estimated that 4,510 deaths (2,790 men and 1,720 women) from CLL will occur this year. The survival rate for people with CLL varies widely according to the stage of the disease (see Stages.)

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with CLL is 83%. 

It is important to remember that statistics on the survival rates for people with CLL are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. People should talk with their doctor if they have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts and Figures 2018, and the ACS website.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Use the menu to choose a different section to read in this guide.

Leukemia - Chronic Lymphocytic - CLL - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 10/2017

ON THIS PAGE: You will find drawings of the main body parts affected by CLL. Use the menu to see other pages.

This illustration of the lymphatic system shows the lymphatic vessels, which are thin tubes that branch out to all parts of the body. It also shows the spleen, located on the left side of the body under the liver, and the thymus, located behind the breastbone. Groups of lymph nodes, tiny bean-shaped organs, are located throughout the body at different areas in the lymphatic system. The largest groups of lymph nodes are shown in the abdomen, groin, pelvis, underarms, and neck. A cross section of a lymph node shows that veins, arteries, and lymphatic vessels allow blood and lymph to flow through a system of lymph nodules in the cortex of the lymph node. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

This illustration of an artery shows various types of blood cells, including the flat red blood cells, multiple types of white blood cells, and the much smaller platelets. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk FactorsIt explains the factors that may increase the chance of developing CLL. Use the menu to choose a different section to read in this guide.

Leukemia - Chronic Lymphocytic - CLL - Risk Factors

Approved by the Cancer.Net Editorial Board, 10/2017

ON THIS PAGE: You will find out more about the factors that increase the chance of developing CLL. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. The cause of CLL is unknown. There is no evidence that exposure to radiation, chemicals, or chemotherapy increases a person’s risk of developing CLL. However, the following factors may raise a person’s risk of developing CLL:

  • Family history. Although it is uncommon, having more than 1 close relative with CLL or some other lymph-related cancer may be linked with an increased risk of CLL. People with a first-degree relative with CLL, such as a parent, sibling, or child, are 2 to 4 times more likely to develop the disease. In order to learn more about families with a history of CLL, there is a registry that affected families can join at the National Cancer Institute.

  • Age. CLL is most common in older adults, is rare in young adults, and hardly ever develops in children. About 90% of people diagnosed with CLL are older than 50. The average age of people diagnosed with CLL is 71.

  • Gender. Men develop CLL more often than women.

  • Race/Ethnicity. B-cell CLL is more common in people of Russian and European descent, and hardly ever develops in people from China, Japan, or Southeast Asian countries. It also occurs commonly in black people. The reason(s) for these differences is not known.

  • Agent Orange. The U.S. Department of Veterans Affairs lists CLL as a disease associated with exposure to Agent Orange, a chemical used during the Vietnam War.

  • Monoclonal B-cell lymphocytosis. This is a condition in which people have higher than usual levels of lymphocytes. But, these levels are not high enough to classify as CLL. There is a slight risk that monoclonal B-cell lymphocytosis can turn into CLL.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems CLL can cause. Use the menu to choose a different section to read in this guide.

Leukemia - Chronic Lymphocytic - CLL - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 10/2017

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with CLL may experience the following symptoms or signs. Most often, people with CLL have no symptoms. Or, the cause of a symptom may be a different medical condition that is not leukemia

Often, people are diagnosed with CLL when the doctor finds many white blood cells during a blood test done for another reason. Also, the immune system of people with CLL may not work well. This means that the body’s immune system sometimes makes abnormal antibodies against their own red blood cells and/or platelets. The antibodies destroy these cells, causing anemia or low numbers of platelets. These type of antibodies are called autoantibodies. People with CLL can develop autoantibodies at any time and this is not necessarily related to the severity of the CLL.

Other possible symptoms of CLL are:

  • Swelling of lymph nodes or glands in the neck, under the arms, or in the groin. This is a common symptom that people with CLL usually notice first. The enlarged lymph nodes are not usually painful.

  • Discomfort or fullness in the upper left part of the abdomen, caused when the spleen increases in size

  • Symptoms often called “B symptoms” that include fever, chills, night sweats, and weight loss

  • Recurrent infections

  • Abnormal bleeding

  • Shortness of breath

  • Fatigue

  • Feeling full despite not eating much

  • Malaise, or generally not feeling well

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If leukemia is diagnosed, relieving symptoms remains an important part of care and treatment. This may be called palliative care or supportive care. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Leukemia - Chronic Lymphocytic - CLL - Diagnosis

Approved by the Cancer.Net Editorial Board, 10/2017

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, CLL. Doctors may also do tests to learn which treatments could work best. For CLL, it may be best to visit a hematologist-oncologist for diagnosis. A hematologist-oncologist is a doctor who specializes in diagnosing and treating blood cancers.

This list describes options for diagnosing CLL. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of leukemia suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

The following tests may be used to diagnose CLL:

  • Blood tests. The process of diagnosing CLL usually begins with a routine blood test called a complete blood count (CBC). A CBC measures the number of different types of cells in a sample of a person’s blood. A person may have CLL if the blood contains too many white blood cells. This result is called a high white blood cell count. The doctor will also use the blood test to find out which types of white blood cells are increased. The CBC also measures red blood cells and platelets. People with CLL may have low levels of these cells. Low levels of red blood cells is called anemia. A low platelet count is known as thrombocytopenia.

    Blood tests may also be used to collect leukemia cells for testing for specific genetic markers that may be used to predict the risk that the disease will worsen (see Genomic and molecular testing, below).

  • Flow cytometry and cytochemistry. In these tests, chemicals or dyes are applied to the leukemia cells in the laboratory. These chemicals and dyes provide information about the leukemia and its subtype. CLL cells have distinctive markers, called cell surface proteins, on the outside of the cell. The pattern of these markers is called the immunophenotype. These tests are used to distinguish CLL from other kinds of leukemia, which can also involve lymphocytes. Both tests can be done from a blood sample. Flow cytometry, also called immunophenotyping, is the most important test to confirm a diagnosis of CLL.

  • Genomic and molecular testing. Your doctor may recommend testing the leukemia cells for specific genes, proteins, chromosome changes, and other factors unique to the leukemia. Because CLL cells divide very slowly, looking at the chromosomes is often less useful than using tests to find specific genetic mutations or changes. Fluorescence in situ hybridization (FISH) assays and other genetic tests, such as polymerase chain reaction, are used to find genetic changes. Some of the genetic changes that occur in CLL include:

    • The deletion of the long arm of chromosome 13 [del(13q)], which is found in about half of patients.

    • An extra copy of chromosome 12 (trisomy 12)

    • del(11q)

    • del(17p)

    • NOTCH1 mutations

    • SF3B1 mutations

    • TP53 abnormalities

    • MYD88 mutations

    • IGVH, which may be important whether it is changed or unchanged

    Results of genetic and molecular testing can determine how quickly the disease will progress and can help determine your treatment options. For example, people with del(17p) are more likely to have difficult-to-treat leukemia and some treatments may work better than others for these patients.

  • Imaging tests. CLL is generally found in many parts of the body, even if the disease has been diagnosed early. Imaging tests are rarely needed to diagnose CLL. They are sometimes used before treatment to find all parts of the body that are affected by CLL or to find out whether particular symptoms may be related to CLL. Imaging tests may also be used to see how well treatment is working.

    • An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. It may show if leukemia is growing in lymph nodes in the chest.

    • A computed tomography(CT or CAT) scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, 3-dimensional image that shows any abnormalities. It can detect lymph nodes with CLL around the heart, windpipe, lungs, abdomen, and pelvis. A CT scan can be used to measure the size of the lymph nodes. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow. There is a risk of kidney problems from this contrast medium; talk with your doctor about this before the test.

      CT scans can also help find out if CLL is in other organs, such as the spleen. If a person has no symptoms when diagnosed, a CT scan is generally not needed. When it is needed, it is usually done only before treatment and at the end of treatment.

  • Bone marrow aspiration and biopsy. CLL is usually diagnosed with blood tests because the cancerous cells are easily found in the blood. A bone marrow biopsy is usually not needed to diagnose CLL, but it may be done before beginning treatment. For some patients, a bone marrow aspiration and biopsy may help determine prognosis, which is the chance of recovery. It may also provide more information about the reasons that other blood tests are abnormal.

    A bone marrow aspiration and biopsy are similar and often done at the same time to examine the bone marrow before starting treatment. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. The skin in that area is usually numbed with medication beforehand. Other types of anesthesia (medication to block the awareness of pain) may also be used.

Your doctor may recommend additional tests before starting treatment to learn more about the leukemia and help plan treatment. After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is leukemia, these results also help the doctor describe the disease. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Leukemia - Chronic Lymphocytic - CLL - Stages

Approved by the Cancer.Net Editorial Board, 10/2017

ON THIS PAGE: You will learn about how doctors describe the growth or spread of CLL. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis. There are different stage descriptions for different types of cancer.

There is a relationship between the stage of the CLL and the prognosis. In general, patients diagnosed at an earlier stage have better long-term survival. Importantly, however, there is a wide range of outcomes even for patients who have the same stage, and the stage alone cannot predict the prognosis with certainty for each person. If the CLL grows and worsens, the stage may change over time.

Below are explanations of commonly used staging and classification systems used by doctors to describe CLL.

Rai staging system

In this staging system, CLL is divided into 5 different stages, from 0 (zero) to IV (4). This staging system classifies the leukemia according to whether a patient has, or does not have, any of the following:

  • Lymphocytosis, which means there are high levels of lymphocytes in the blood

  • Lymphadenopathy, meaning a patient has enlarged lymph nodes

  • Splenomegaly, which is an enlarged spleen

  • Anemia, meaning low levels of red blood cells

  • Thrombocytopenia, meaning low levels of platelets

  • Hepatomegaly, which is an enlarged liver

Rai stage grouping

Stage 0: The patient has lymphocytosis with more than 5000 lymphocytes per microliter of blood, but no other physical signs.

Stage I: The patient has lymphocytosis and enlarged lymph nodes. The patient does not have an enlarged liver or spleen, anemia, or low levels of platelets.

Stage II: The patient has lymphocytosis and an enlarged spleen and/or liver and may or may not have swollen lymph nodes.

Stage III: The patient has lymphocytosis and anemia. The patient may or may not have swollen lymph nodes and an enlarged liver or spleen.

Stage IV: The patient has lymphocytosis and low levels of platelets. The patient may or may not have swollen lymph nodes, an enlarged liver or spleen, or anemia.

This chart summarizes the Rai stages.

Rai Stage High levels of lymphocytes Enlarged lymph nodes Enlarged spleen or liver Anemia Low levels of platelets

0

Yes

No

No

No

No

I

Yes

Yes

No

No

No

II

Yes

Yes or no

Yes

No

No

III

Yes

Yes or no

Yes or no

Yes

No

IV

Yes

Yes or no

Yes or no

Yes or no

Yes

Chart adapted from the American Society of Hematology, Kay et. al. 2002, vol. 1:193, Table 8.

Rai stage risk groups

Sometimes the phrase “risk group” is used to indicate the likelihood that the disease may worsen and require treatment.

Low risk: Rai stage 0

Intermediate risk: Rai stages I and II

High risk: Rai stages III and IV

Binet classification

European doctors use a different staging system, based on whether the CLL is found in the lymph nodes in the neck, under the arms, or in the groin area and whether the patient has low levels of red blood cells or platelets. The stages are called A, B, and C.

Stage A: The patient does not have anemia or low levels of platelets. The leukemia can be felt in fewer than 3 areas of lymph nodes (Rai stages 0, I and II).

Stage B: The patient does not have anemia or low levels of platelets. The leukemia is in 3 or more areas of lymph nodes (Rai stages I and II).

Stage C: The patient has anemia and/or low levels of platelets. The leukemia is in any number of lymph nodes (Rai stages III and IV).

This chart summarizes the Binet stages

Binet stage Number of enlarged lymph node areas Anemia Low levels of platelets
A

Less than 3

No

No

B

3 or more

No

No

C

Any number

Yes (or low platelets)

Yes (or anemia)

Chart adapted from the American Society of Hematology, Kay et. al.2002, vol. 1:193, Table 8.

Information about the leukemia’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Leukemia - Chronic Lymphocytic - CLL - Types of Treatment

Approved by the Cancer.Net Editorial Board, 10/2017

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with CLL. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for CLL. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of existing drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment options and recommendations depend on several factors, including the type and stage of leukemia, possible side effects, and the patient’s preferences, age, and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Because CLL often develops slowly, many people may not need treatment right away, and some may never need treatment at all. Although the current standard treatments can be highly effective, it is uncertain whether any treatment can completely get rid of CLL, and most patients are not cured of the disease with treatment. The goal of treatment is to ease symptoms and produce a long-term remission (see below).

Descriptions of the common types of treatment used for CLL are listed below. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Watch and wait/active surveillance for early-stage CLL

Patients with symptoms and/or large amounts of CLL in the blood, lymph nodes, or spleen often need treatment shortly after diagnosis. For other patients, however, immediate treatment is not needed. For these people, it is recommended that the disease be monitored carefully without active treatment. This is the standard approach for patients with early-stage disease and no symptoms. This approach might be hard to understand, which can be stressful. However, patients may find that their concerns about this approach lessen over time. Talk with your health care team if you have questions or concerns.

During this time, the patient’s blood counts are watched closely and physical examinations are performed on a regular basis. If the CLL shows signs of worsening, active treatment would then begin. Research studies have shown that no harm comes from the watch-and-wait approach, also called active surveillance or watchful waiting, when compared with immediate treatment for early-stage CLL. Some patients do not develop symptoms for years, or even decades, and will never need any treatment. Patients who have not had their blood counts change over several months or years may only need to have these checked every 3 to 6 months.

Although many patients can live comfortably with CLL without active treatment, it is beneficial to use this time to improve overall health. This includes stopping smoking and bringing all immunizations up to date. However, patients with CLL should not receive the herpes zoster (shingles) vaccine because it may cause a shingles infection in patients who have a lowered immune system.

Treatment is recommended for people with worsening blood counts who have also developed symptoms. These symptoms might include increased fatigue, night sweats, enlarged lymph nodes, or lowered red blood cell or platelet counts. People with CLL are encouraged to talk with their doctor about whether their symptoms need treatment, balancing the benefits of treatment with the risk of side effects

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a hematologist-oncologist.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). Systemic therapies may also be given as an injection under the skin, called a subcutaneous injection.

The types of systemic therapies used for CLL include:

  • Chemotherapy

  • Targeted therapy

Each of these types of therapies are discussed below in more detail. A person may receive only 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy. Clinical trials evaluating other drugs are described in Latest Research.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide.

Common drugs for CLL include:

  • Bendamustine (Bendeka, Treanda)

  • Fludarabine (Fludara), most common for people with CLL who are younger and do not have a deletion in chromosome 17

  • Pentostatin (Nipent)

  • Cladribine (Leustatin)

  • Chlorambucil (Leukeran)

  • Cyclophosphamide (Cytoxan)

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy.

Targeted therapy

Targeted therapy is a treatment that targets the leukemia’s specific genes, proteins, or the tissue environment that contributes to its growth and survival. This type of treatment blocks the growth and spread of leukemia cells while limiting damage to healthy cells.

Not all cancers have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your leukemia. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments. Targeted therapy for CLL includes:

  • Monoclonal antibodies. A monoclonal antibody recognizes and attaches to a specific protein in the surface of leukemia cells, and it does not affect cells that do not have that protein. Monoclonal antibodies for CLL include:

    • Rituximab (Rituxan)

    • Ofatumumab (Arzerra)

    • Obinutuzumab (Gazyva)

    • Venetoclax (Venclexta) for patients with CLL that has returned after treatment and with a deletion in chromosome 17

  • Kinase inhibitors. Kinases are enzymes found in both healthy cells and cancer cells. Some cancer cells can be destroyed by drugs that block a particular kinase enzyme. Kinase inhibitors for CLL are fairly new and may only be available for patients with CLL that has returned (called recurrent CLL) or worsened (called refractory CLL) or in clinical trials.

    • Ibrutinib (Imbruvica) is approved for people with CLL who have already received at least 1 other treatment. It is also approved as the first treatment for patients with a deletion in chromosome 17. However, it may cause bleeding and is not recommended for patients taking blood thinners.

    • Idelalisib (Zydelig) is another type of kinase inhibitor that is given orally. It is also approved for the treatment of recurrent CLL in combination with rituximab.

The side effects of targeted therapy depend on the drug used. Often, a person’s first treatments with rituximab, obinutuzumab, or ofatumumab cause fevers and chills, which usually go away after the first few treatments. Treatment with venetoclax may cause kidney failure and tumor lysis syndrome (TLS), a life-threatening medical emergency that could occur after treatment. However, your doctor may prescribe certain medications to help relieve these symptoms. Learn more about when to call the doctor during cancer treatment.

Combining systemic therapies

A treatment regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. Sometimes, a doctor may use a combination of drugs, but a combination of drugs is not always better than a single drug. When treatment begins, doctors may use a number of different drugs depending on the stage of the disease and the person’s age and health.

The combinations listed below may be used for CLL. Combinations that include fludarabine are generally used for younger patients:

  • Rituximab and fludarabine (sometimes abbreviated as FR)

  • Cyclophosphamide and fludarabine (called FC)

  • Cyclophosphamide, fludarabine and rituximab (called FCR)

  • Pentostatin, cyclophosphamide, and rituximab (called PCR)

  • Bendamustine and rituximab (called BR)

  • Idelalisib and rituximab for patients with recurrent CLL

  • Obinituzumab and chlorambucil for older patients

  • Ibrutinib, bendamustine, and rituximab for recurrent CLL

Bone marrow transplantation/stem cell transplantation

A bone marrow transplant is a medical procedure in which bone marrow that contains leukemia is replaced by highly specialized cells, called hematopoietic stem cells, that develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is the stem cells in the blood that are typically being transplanted, not the actual bone marrow tissue.

There are 2 types of stem cell transplantation depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). ALLO uses donated stem cells, while AUTO used the patient’s own stem cells. ALLO is the type of transplant used for treating CLL and is typically considered for younger patients either when the standard treatments have not worked well or the patient has a high risk of the CLL returning more quickly. The goal is to destroy all of the cancer cells in the marrow, blood, and other parts of the body using high doses of chemotherapy and/or radiation therapy and then allow replacement blood stem cells to create healthy bone marrow.

Side effects depend on the type of transplant, your general health, and other factors. Learn more about the basics of stem cell and bone marrow transplantation.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. Radiation therapy is not often used to treat CLL because the disease is located throughout the body. However, radiation therapy can be very helpful to shrink an enlarged spleen or swollen lymph nodes and relieve certain symptoms.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.

Surgery

Occasionally, surgery to remove the spleen, called a splenectomy, may be recommended because the spleen can become very enlarged in a person with CLL. A surgical oncologist is a doctor who specializes in treating cancer using surgery.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of surgery.

Care for symptoms and side effects

Leukemia and its treatment often cause side effects. In addition to treatments intended to slow, stop, or eliminate the disease, an important part of care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the leukemia at the same time that they receive treatment to ease side effects. In fact, people who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the CLL, such as chemotherapy or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Palliative treatments for CLL may include:

  • Immunoglobulin for infections that keep coming back. Given by IV each month, this may be helpful because people with CLL have fewer normal antibodies to help them fight infections.

  • High doses of corticosteroids can help the body stop making antibodies that destroy red blood cells and/or platelets.

  • A splenectomy (see Surgery, above), for patients who make antibodies against their own healthy blood cells.

  • Rituximab may also be helpful if a patient’s immune system makes antibodies against the body’s own blood cells (see Symptoms and Signs).

Before treatment begins, talk with your health care team about the possible side effects of the specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Refractory CLL

If the leukemia does not respond to treatment, the disease is called refractory. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

If CLL becomes resistant to 1 drug, meaning that the drug no longer works, other treatments or drugs are often recommended. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of refractory CLL is very stressful and, at times, difficult to bear. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission

The goal of treatment is to relieve any symptoms from CLL and to reduce the amount of remaining CLL as much as possible. A complete remission (CR) occurs when the doctor cannot find any evidence of leukemia remaining after repeated testing. A partial remission (PR) is when there is some leukemia remaining.

A PR is most common for people with CLL who receive the current standard treatments. With a PR, patients can feel quite well with normal blood counts, have no swollen lymph nodes or spleen, but still have detectable amounts of CLL in the bone marrow.

New monitoring methods, called minimal residual disease (MRD; cancer cells not destroyed by treatment) methods, are better able to find fewer abnormal lymphocytes, as well as tell the difference between the abnormal and healthy lymphocytes. MRD methods are now being used more often to determine depth of remission in patients with CLL.

The goal of newer, more intensive treatments or targeted therapies is to destroy more cancer cells in the hope of lengthening a person’s life. In the future, the definition of a CR in CLL is likely to change with advances in technology. For example, some sensitive tests can find very small levels of the abnormal DNA changes specific to CLL. When these sensitive tests can no longer find any CLL, it is called a molecular remission.

The chance of recurrence

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Recurrent CLL is CLL that has come back after treatment. While many remissions last for a long time, it is important to talk with your doctor about the possibility of the disease returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the leukemia does return. Learn more about coping with the fear of recurrence.

If there is a recurrence, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as chemotherapy and targeted therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent leukemia. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

Finding a CLL recurrence does not mean that treatment is needed right away. In fact, the watch-and-wait approach (see above) is usually recommended, with active treatment beginning only if the disease causes symptoms again.

People with recurrent leukemia often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Recovery from leukemia is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

People who have advanced disease and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

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ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with CLL. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some people, a clinical trial is the best treatment option available. Because standard treatments are not perfect, people are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating CLL. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with CLL.

Insurance coverage of clinical trial costs differs by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” Placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options, so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

People who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for CLL, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research It explains areas of scientific research currently going on for CLL. Use the menu to choose a different section to read in this guide.

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ON THIS PAGE: You will read about the scientific research being done now to learn more about CLL and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about CLL, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Most cancer centers are focused on clinical trials aimed at increasing the number of patients who have a complete remission. Always talk with your doctor about the best diagnostic and treatment options for you.

  • New drugs and drug combinations. Researchers are working to find new drugs for CLL. Different combinations of chemotherapy and targeted therapy are also being studied as a way to increase the likelihood that a patient will have a complete remission and live longer. There are many new drugs for CLL, including many new kinase inhibitors, being evaluated in clinical trials for people with recurrent CLL with the hope of testing some of these drugs as initial therapy in the near future.

    • Researchers are also looking at combining ibrutinib with bendamustine, ofatumumab, and rituximab and ibrutinib with fludarabine, cychlophosphamide, and rituximab. Ibrutinib is also being researched along with venetoclax.

    • Idelalisib is being studied in combination with bendamustine, rituximab, and ofatumumab.

    • Xm5574 is a monoclonal antibody also being researched for treatment of CLL.

    • Lenalidomide (Revlimid) is drug commonly used to treat multiple myeloma that is also being looked at as a treatment for CLL, either by itself or in combination with several different drugs for people with recurrent or refractory CLL, as well as for those who have not yet received treatment.

    • Dinaciclib is another drug being researched for CLL.

    • Duvelisib, a type of kinase inhibitor, is also being researched.

  • Genetics. Genetic changes specific to CLL cells are also being evaluated to help predict how well treatment will work, determine the best treatment, and provide information about the cause of the disease. Examples include:

    • Measuring the immunoglobulin mutations of the CLL cells

    • Finding different chromosomal abnormalities in the CLL cells

    • Studying the effects of a protein called ZAP-70, which is found on the surface of the CLL cells

    Some research suggests that these markers can predict the likelihood that the disease may worsen faster. However, there is often a large difference in how well treatment works for patients who seem to have the same genetic markers. It is too early to use these tests to make decisions about when to begin treatment and the type of treatment to use.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current CLL treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding CLL, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of CLL and its treatment. This page includes several links outside of this guide to other sections of this website. Use the menu to see other pages.

Every treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of leukemia. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of treatment “palliative care” or "supportive care." It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for CLL are listed in the Types of Treatment section. Learn more about side effects of leukemia and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the leukemia’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a CLL diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people do not know what to say in response.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Treatment can be expensive. For CLL, some drugs can be costly and may only be partially covered by health insurance. Treatment cost is often a big source of stress and anxiety for people with CLL and their families. However, many drug companies and other organizations have programs that can help with the costs.

In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with CLL. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your health care team about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, and social effects of leukemia.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of check-ups after treatment is finished. Use the menu to choose a different section to read in this guide.

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ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with CLL does not end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

People diagnosed with CLL have a higher risk of developing other cancers, particularly lung, colon, or skin cancers. They should tell their doctors if they notice new symptoms or worsening skin problems or moles. The types of chemotherapy used for CLL may damage the DNA in healthy bone marrow cells and cause a different type of leukemia several years later. This is called therapy-related myeloid leukemia.

People who received treatment for CLL should also tell their doctors right away if they notice any change in how they feel or develop new symptoms. It’s important not to wait until your next appointment to talk with your doctor about these changes. Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Leukemia recurs because a small number of leukemia cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to keep track of the treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a CLL diagnosis. Use the menu to choose a different section to read in this guide.

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ON THIS PAGE: You will read about how to cope with challenges in everyday life after a diagnosis of CLL. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having CLL. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the health care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with CLL, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People diagnosed with CLL are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your health care team. Use the menu to choose a different section to read in this guide.

Leukemia - Chronic Lymphocytic - CLL - Questions to Ask the Health Care Team

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ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to help manage your care.

Questions to ask after getting a diagnosis

  • What is my diagnosis?

  • Can you explain my pathology report (laboratory test results) to me?

  • What stage or risk group is the CLL? What does this mean?

  • Should I get a second opinion before starting treatment?

Questions to ask about choosing a treatment and managing side effects

  • Who will be leading my overall treatment?

  • How often do you treat people with CLL?

  • Where is the best place for me to be treated?

  • Will I need to stay in the hospital for treatment?

  • What are my options for treatment?

  • What is the goal of each treatment option?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • If a clinical trial is recommended, will I receive treatment nearby or will I need to travel to the treatment center?

  • What is the goal of each treatment? Is it to eliminate the leukemia, help me feel better, or both?

  • Who will be part of my health care team, and what does each member do?

  • Do I need to start treatment right away? If not, please explain why treatment does not need to begin as soon as possible.

  • What are the possible side effects of this treatment, both in the short term and long term?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of medical care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call with questions or problems?

Questions to ask about having targeted therapy or chemotherapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the CLL will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the treatment I received?

  • What survivorship support services are available to me? To my family?

  • What follow-up tests will I need, and how often will I need them?

  • Who will be leading my follow-up care?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Use the menu to choose a different section to read in this guide.

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ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Chronic Lymphocytic Leukemia. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Cancer.Net:

This is the end of the Cancer.Net’s Guide to Chronic Lymphocytic Leukemia. Use the menu to choose a different section to read in this guide.