TRAINING and EDUCATION
Patient Education
Chronic Lymphocytic Leukemia/
Small Lymphocytic Lymphoma
What is Chronic Lymphocytic Leukemia/
Small Lymphocytic Lymphoma?
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are cancers that affect the same
lymphocytes, a type of white blood cell. CLL and SLL are
essentially the same disease, with the only difference being the location where the cancer primarily occurs:
• When most of the cancer cells are located in the
bloodstream and the bone marrow, the disease is
referred to as CLL, although the lymph nodes and
spleen are often involved.
• When the cancer cells are located mostly in the
lymph nodes, the disease is called SLL.
• Alemtuzumab
• Bendamustine
• Idelalisib
• Chlorambucil
• Ofatumumab
• Fludarabine
• Rituximab
• Ibrutinib
• Lenalidomide with or without rituximab
• R-CHOP (rituximab, cyclophosphamide, doxorubicin,
vincristine, and prednisone)
How is CLL/SLL Diagnosed?
Treatments Under Investigation
Many patients with CLL/SLL do not have any obvious
symptoms of the disease. Their doctors might detect the
disease during a routine blood test and/or a physical examination. For others, the disease is detected when symptoms occur and the patient goes to the doctor because he
or she is worried, uncomfortable, or does not feel well.
If symptoms occur, they may be different for each
patient due to the location of the tumor in the body. The
symptoms of CLL/SLL include a tender, swollen abdomen and feeling full even after eating only a small amount.
Other symptoms of CLL/SLL can include fatigue, shortness of breath, anemia, bruising easily, night sweats,
weight loss, and frequent infections. However, many
patients with CLL/SLL will live for years without symptoms.
Many treatments are currently being tested in clinical
trials for both newly diagnosed and relapsed/refractory
CLL/SLL patients.
Treatment Options
Cut out and give to a patient
For patients who become refractory or relapse, secondary therapies may be successful in providing another
remission. Some common single-agent and combination
therapies used in the relapsed/refractory setting include:
Treatment is based on the severity of associated symptoms as well as the rate of cancer growth. If patients show
no or very few symptoms, doctors may decide not to treat
the disease right away, an approach referred to as “watch
and wait” or “watchful waiting.” Studies have shown that
patients suitable for a “watch and wait” approach have
outcomes similar to those treated early in the course of
their disease. However, patients with high-risk disease may
need to start treatment right away.
There are many first-line treatment options for CLL/
SLL. The choice of treatment will depend on the stage of
the disease, whether or not the patient is experiencing
symptoms, the age and overall health of the patient, and
the benefits versus side effects of treatment.
It is not yet clear if stem cell transplantation is helpful
for patients with CLL/SLL. Stem cell transplants are usually done as part of a clinical trial in patients with highrisk or relapsed (returns after treatment) or refractory
(does not respond to treatment) disease. Typically, stem
cells from a donor are used.
Common drugs or combinations of drugs used as
initial treatments for CLL/SLL include:
• BR (bendamustine and rituximab)
• CO (chlorambucil and obinutuzumab)
• FCR (fludarabine, cyclophosphamide, and rituximab)
• FR (fludarabine and rituximab)
• Ibrutinib (for patients with 17p deletions)
• Ofatumumab and chlorambucil
• PCR (pentostatin, cyclophosphamide, and rituximab)
ASHClinicalNews.org
• Chemoimmunotherapy agents are being explored as
induction therapy in newly diagnosed patients.
• Researchers are also investigating ways to improve
stem cell transplantation in patients with CLL/SLL.
• Genetically engineered immune cells, or T cells,
designed to recognize and kill CLL cells are another
area of research for treating CLL. It is critical
to remember that today’s scientific research is
continuously evolving.
Treatment options may change as new therapies are discovered and current therapies are improved. Therefore,
it is important that patients check with their physician for
any treatment updates that may have recently emerged.
Clinical trials are crucial in identifying effective drugs
and determining optimal doses for patients with lymphoma. Patients interested in participating in a clinical trial
should talk with their physician.
Lymphoma Research
Foundation Patient
Resources
The Lymphoma Research
Foundation (LRF) offers patients
with lymphoma and CLL a wide
range of resources that provide a
comprehensive overview as well
as address treatment options,
the latest research advances, and
ways to cope with all aspects of
lymphoma
LRF also provides many
educational activities, from
in-person meetings to
teleconferences and webcasts, as
well as an Understanding Chronic
Lymphocytic Leukemia and Small
Lymphocytic Lymphoma booklet,
e-Updates that provide the
latest disease-specific news and
treatment options, and an awardwinning mobile app (Focus on
Lymphoma) that provides tools to
help manage the disease.
For more information about
any of these resources, visit the
Lymphoma Research Foundation’s
websites at www.lymphoma.org
or www.FocusOnCLL.org or contact
the LRF Helpline at 800-5009976 or [email protected].
Follow-Up
Because CLL/SLL is generally characterized by multiple
disease relapses after responses to a variety of treatments, patients in remission should have regular visits
with a physician who is familiar with their medical his ѽ