Your doctor will take several factors into consideration (e.g., your symptoms, test results, and how you’re feeling) when determining whether another treatment should begin.
Do not stop or change your current treatment based only on a test result without speaking with your healthcare team.
Progression doesn’t always mean starting treatment right away
Disease progression does not always mean that another treatment needs to start immediately. Some people with evidence of progression continue to be monitored until the disease causes significant symptoms Signs that show something might be wrong, like pain or feeling tired. , worsening blood counts, rapidly enlarging lymph nodes or spleen, or other established reasons to start treatment.
Why your previous treatment matters
If CLL/SLL progresses during ongoing treatment, your healthcare team will consider whether the disease has become resistant to that treatment and whether a therapy that works differently is needed.
Stopping treatment due to disease progression is different from stopping treatment because of side effects or tolerability. If a treatment controlled the disease but was hard to tolerate, another treatment in the same class may still be an option. Treatment within a class can differ in effectiveness, side-effect profiles, interactions with other medicines, and how they’re taken. To learn more, see Questions to Ask About Side Effects of CLL Treatments.
Testing for resistance mutations related to changes in treatment response may also help determine whether a treatment in the same class remains appropriate, or whether a different treatment approach should be considered.
Planning a safe transition
Your doctor will explain when it’s time to stop your current treatment and when it’s time to begin the next one. In some circumstances, careful coordination is important to reduce the risk of the disease becoming more active during the transition.
Do not stop, overlap, or start treatments on your own. Always follow the transition plan provided by your healthcare team.
Consider all appropriate treatment options
The next treatment decision depends on your prior treatments, why each one ended, disease characteristics, other health conditions, differences in effectiveness and your goals and preferences.
For some, a clinical trial may provide access to a treatment strategy being studied. This may be worth discussing with your doctor, particularly when the disease has progressed after multiple prior treatments. For more information, see CLL & SLL Clinical Trials FAQs.
Questions to ask your doctor
- What findings show that my CLL/SLL has progressed?
- Do I need another treatment now, or can I continue to be monitored?
- Are additional tests needed before choosing my next treatment, including tests to detect changes in my CLL/SLL that may make some treatments less likely to work (e.g., development of drug-resistant mutations or genomic alterations)
- Did my previous treatment stop working, or was it stopped because of side effects?
- If it was stopped because of side effects, could another treatment in the same class be appropriate?
- How do the options compare in their ability to provide lasting disease control?
- How do risks of heart rhythm problems, high blood pressure, bleeding, infections, and other side effects compare?
- How might my heart health, other medical conditions, and current medicines affect the choice?
- Are there differences in dosing, drug interactions, or treatment duration that could make one option a better fit for me?
- How will the transition between treatments be managed?
- Is a clinical trial an appropriate option for me?
- What are the goals, possible benefits, and risks of each option?
Bring this list with you to your next appointment, or ask your healthcare team which of these questions matter most for your specific situation.
