Perspectives for CLL patients and their families
If, after a diagnosis of chronic lymphocytic leukaemia (CLL), you are looking for a treatment that suits you, you are on the right way to find it. Nowadays modern therapies are tailor-made for the patient, in this article, it will emerge clearly how much the evolution of the therapy allows to adjust the treatment on the patient.
What is chronic lymphocytic leukaemia?
Chronic lymphocytic leukaemia (CLL) is a type of cancer of the bone and blood marrow.
CLL can be asymptomatic, symptomatic or progressive, refractory, or recurrent.
- Asymptomatic CLL: The leukaemia causes no or few symptoms.
- Symptomatic or progressive CLL: The leukaemia has caused significant changes to blood counts or other serious symptoms.
- Recurrent CLL: The leukaemia has recurred (come back) after a period in which cancer could not be detected.
- Refractory CLL: The leukaemia does not get better with treatment.
CLL is one of the most common types of leukaemia in adults. It often occurs during or after middle age. However, it is important to understand that this cancer gets worse slowly. The first treatment approach is to watch and wait, which is a way of monitoring with regular check-ups and blood tests. The idea of standing and watching without doing anything can be challenging for many patients, but it is important to know that learning to live in an active form with CLL is the most powerful approach to managing this cancer.
How is chronic lymphocytic leukaemia diagnosed?
Several tests are done to find out the staging of CLL, the process used to find out how far cancer has spread. It is important to know whether the leukaemia cells have spread to plan the best treatment.
The stages go from 0 to IV, as follows:
- In stage 0 there are too many lymphocytes in the blood, but there are no other signs or symptoms of leukaemia. We are in a slow-growing phase.
- In stage I there are too many lymphocytes in the blood and the lymph nodes are larger than normal.
- In stage II there are too many lymphocytes in the blood, the liver or spleen is larger than normal, and the lymph nodes may be larger than normal.
- In stage III there are too many lymphocytes in the blood and there are too few red blood cells. The lymph nodes, liver, or spleen may be larger than normal.
- In stage IV there are too many lymphocytes in the blood and too few platelets. The lymph nodes, liver, or spleen may be larger than normal or there may be too few red blood cells.
The currently used treatment are standard and some are being tested in clinical trials.
How is chronic lymphocytic leukaemia treated?
There are six types of treatment currently in use, from targeted therapy to immunotherapy.
Targeted therapies
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy does.
Different types of targeted therapy are used to treat CLL:
- Tyrosine kinase inhibitor (TKI) therapy: This treatment blocks the enzyme, tyrosine kinase, which causes stem cells to develop into more white blood cells than the body needs. Ibrutinib, acalabrutinib, idelalisib, and duvelisib are TKIs used to treat symptomatic or progressive, recurrent, or refractory CLL.
- BCL2 inhibitor therapy: This treatment blocks a protein called BCL2 which is found in some leukaemia cells. This may kill leukaemia cells and make them more sensitive to other anticancer drugs. Venetoclax is a type of BCL2 therapy used to treat symptomatic or progressive, recurrent, or refractory CLL.
- Monoclonal antibody therapy: Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Rituximab, ofatumumab, and obinutuzumab alone and in combination with chemotherapy are used to treat symptomatic or progressive, recurrent, or refractory CLL.
- Alemtuzumab has been studied for the treatment of CLL. Studies showed that alemtuzumab did not help patients live longer.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer, such as a group of lymph nodes or the spleen. This treatment may be used to reduce pain related to a swollen spleen or lymph nodes.
Immunotherapy
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defences against cancer. This cancer treatment is a type of biological therapy. Immunomodulating agent: Lenalidomide stimulates T cells to kill leukaemia cells. It may be used alone or with rituximab in patients with symptomatic or progressive, recurrent, or refractory CLL.
CAR T-cell therapy
This treatment changes the patient’s T cells (a type of immune system cell) so they will attack certain proteins on the surface of cancer cells. T cells are taken from the patient and special receptors are added to their surface in the laboratory. The changed cells are called chimeric antigen receptor (CAR) T cells. The CAR T cells are grown in the laboratory and given to the patient by infusion. The CAR T cells multiply in the patient’s blood and attack cancer cells. CAR T-cell therapy is being studied in the treatment of recurrent or refractory CLL.
Chemotherapy with bone marrow or peripheral stem cell transplant
Chemotherapy is given to kill cancer cells. Healthy cells, including blood-forming cells, are destroyed by the cancer treatment. A bone marrow or peripheral stem cell transplant are treatments to replace the blood-forming cells. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the patient completes chemotherapy, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
Treatment options depend on the red blood cell, white blood cell, and platelet blood counts, whether the liver, spleen, or lymph nodes are larger than normal, the age and health of the patient at the time of diagnosis and whether there are signs or symptoms, such as fever, chills, or weight loss, the response to initial treatment and whether the CLL has recurred.
Each cancer treatment and cancer can cause side effects. Keep in mind that side effects vary from person to person, even among people receiving the same type of cancer treatment. Speak up about any problems you have. Your health care team can treat and/or talk with you about ways to reduce side effects, so you feel better.
You can get more help from the Chronic Lymphocytic Leukaemia Association where you live and of course, your physician can help you to choose the best option for you.
Disclaimer
The information contained herein is not and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Before making any changes to your diet, exercise or treatment, always consult your doctor or a qualified health professional.
The guidance provided may not be appropriate for your specific situation. Never make any decisions about your health based solely on the information provided in this article.
The author and creator of this article are not responsible for any damage or loss resulting from the improper use of the information presented here. Remember that each person is unique and therefore needs a personalized approach to health.
If you have any concerns about your health, please consult a qualified medical professional.