Chronic lymphoblastic leukemia is usually a non-aggressive cancer that develops in older people. It can be treated with chemotherapy. Developed countries can also offer other, more effective, drug treatment options such as monoclonal antibodies and targeted therapy. Less commonly, stem cell transplantation and radiotherapy are performed.
Chronic lymphocytic leukemia accounts for a third of all cases of leukemia. It does not develop as quickly as the acute form of pathology. With quality treatment provided, people with CLL (chronic lymphocytic leukemia) usually have a long-life expectancy.
At the same time, the disease is considered incurable. There is no evidence that early initiation of therapy improves patient survival rates. Therefore, some patients do not receive treatment immediately. They are observed, and the treatment for chronic lymphocytic leukemia is carried out after the manifestation of signs of progression of the disease.
The treatment is preceded by a thorough diagnosis, since the therapeutic tactics as a whole depend on its results and the advisability of using certain drugs is determined. Doctors carry out a bone marrow biopsy.
Symptoms
Many people with chronic lymphocytic leukemia have no symptoms at first. Signs and symptoms might develop as the cancer progresses. They might include:
Blood tests: The care team may order several blood tests as part of the CLL diagnosis process.
Bone marrow aspiration and biopsy: This procedure is generally not needed to diagnose CLL, as blood tests are good at discovering cancerous cells. However, some patients may have this test done before treatment to reveal more about the cancer.
Imaging tests: Imaging tests, such as X-rays and computed tomography (CT) scans, use different techniques to generate images inside the body. These scans are generally not needed to diagnose CLL but may be used to discover where cancer has spread.
Treatment
Chemotherapy is the main treatment option. Doctors use a combination of several medicines that suppress cancer cells. Chemotherapy is carried out in cycles of 3-4 weeks. There are breaks between them so that the body can recover.
Most patients with chronic lymphocytic leukemia are elderly people. Chemotherapy may not be safe for them. patients are carefully examined to make sure that it will be safe for their health to use standard doses of chemotherapy drugs. Age itself is not a contraindication to chemotherapy, but in the presence of concomitant pathologies, doctors can use more sparing treatment regimens.
To conduct chemotherapy for chronic lymphocytic leukemia, doctors use alkylating agents, purine analogs and glucocorticoids. They are often combined with monoclonal antibodies.
Monoclonal antibodies
In countries with advanced medicine, monoclonal antibodies are part of the standard treatment for chronic lymphocytic leukemia. Doctors use drugs that target the CD20 antigen. Some medications can be used as first-line therapy in addition to standard chemotherapy. They can also be applied instead of chemotherapy if it is contraindicated due to the patient's weakened health. Other monoclonal antibodies are prescribed as second-line medicines if chronic lymphocytic leukemia recurs after treatment.
Less commonly, other monoclonal antibodies can be used. These antibodies are targeting the CD52 receptors. Such medicines are used as second-line agents. They can also be applied as a standard treatment option for chronic lymphocytic leukemia with chromosome 17 deletion.
To treat chronic lymphocytic hairy cell leukemia, the medicines targeting CD22 are used. Doctors use an antibody-drug conjugate. It contains two components, namely, a substance that can bind to the CD22 receptor and a toxin that is delivered to the cancer cell and destroys it.
Targeted therapy is first-line treatment for patients with chronic lymphocytic leukemia. This means that the therapy is prescribed immediately after the detection of pathology, but not in case of its relapse or failure of other treatment options.
Doctors use BTK (Bruton's Tyrosine Kinase) inhibitors. They are taken in pills or capsules. The medicines are used as first-line therapy and for recurrence of chronic lymphocytic leukemia. The treatment is effective in patients with chromosome 17 deletion. BTK inhibitors have few side effects, but they suppress bone marrow function. Blood contains too few red blood cells, platelets and leukocytes. Both immunity and blood clotting are impaired, which can adversely affect the health of patients.
PI3K inhibitors can be used only as second-line therapy. The drugs are prescribed if other treatments have failed. They are also taken in pills.
With chronic lymphocytic leukemia, stem cell transplant can be performed less frequently than in acute. Typically, chemotherapy, monoclonal antibodies, and targeted therapy can successfully restrain the progression of the disease. In addition, mostly elderly people get sick, and they are not always healthy enough to perform this procedure, which is unsafe for health.
Nonetheless, in some cases, cancer returns. For repeated treatment of the disease, standard therapy options are not always effective. Failures are especially common in prognostically unfavorable types of chronic lymphocytic leukemia: with chromosome 17 deletion and TP53 mutation.
In theory, any, even the most aggressive, tumors can be suppressed with chemotherapy. This is purely a matter of dosage. But in practice, it will not work to increase the dose indefinitely, because healthy cells are also affected by chemotherapy, and primarily those that are quickly divided. The high-dose chemotherapy has high toxicity to the bone marrow, which dies and stops producing healthy blood cells.
The problem can be solved with stem cell transplant. Doctors carry out high-dose chemotherapy. It destroys not only the tumor, but also the patient's own bone marrow. To restore it, stem cells are injected into the blood, either the patient's own or donated ones. Previously, they were obtained from bone marrow, which is why the procedure is called bone marrow transplant. But in modern medicine, cells are more often taken from the patient's peripheral blood.
Depending on which cells are used for the transplant procedure, the transplantation can be:
Autologous transplantation is safer. The cells are definitely not rejected, and they do not cause a graft-versus-host disease. Nonetheless, the disadvantage of this method is that it is almost impossible to cure cancer. Together with stem cells, malignant cells inevitably enter the bloodstream, and thus they give rise to the growth of a new tumor. Therefore, sooner or later, cancer will recur.
When treating chronic lymphocytic leukemia, doctors often use allogeneic transplantation. It is better if there is a suitable donor from among the next of kin. The donor must be compatible for the main antigens. The more antigens match, the higher the chance of a successful outcome of the procedure.
Chronic lymphocytic leukemia can be cured with allogeneic transplantation. Firstly, transplantation does not imply the transfer of malignant cells into the patient's blood. Second, after new bone marrow is formed, it attacks the remaining cancer cells more aggressively by activating the graft-versus-cancer disease.
While radiotherapy is one of the main treatment options for other types of cancer, it can rarely be used for leukemia. Radiotherapy does not affect the patient's survival rate. It is mainly used to relieve symptoms.
The three most common situations when doctors use radiotherapy for chronic leukemia are:
Surgical operations for chronic leukemia can rarely be performed. They do not help cure this disease.
Sometimes doctors perform surgery to remove the spleen. It is required if the enlarged spleen presses on the surrounding organs, but it is not possible to reduce its size with the help of chemotherapy and irradiation.
The spleen is the organ responsible for the destruction of blood cells. Therefore, its removal has an additional positive effect on the clinical course of the disease. In hairy cell leukemia, splenectomy can sometimes be performed in order to increase the number of cells and reduce the need for blood transfusions.
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1-Diagnosis:
The program includes:
Required documents
Price from: on request
Type of program: Outpatient
Expected duration of the program: 6 days
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2-Chemotherapy:
The program includes:
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