Two treatment approaches
Learning how these approaches differ—and how your personal health and biomarkers influence treatment—can help you and your doctor choose a plan with confidence.
- Continuous regimen
- Fixed-duration regimen
Where do I begin?
(Fluorescence In Situ Hybridization)
done at diagnosis or before your first treatment is started & every time you are considering beginning a new treatment
(Immunoglobulin Variable Heavy chain)
done at diagnosis or before your first treatment is started
(Tumor Protein 53)
done at diagnosis or before your first treatment is started & every time you are considering beginning a new treatment
Biomarker testing is performed at diagnosis to derive prognostic and predictive information from genetic mutations and chromosomal abnormalities associated with CLL, which can inform the treatment plan
The following biomarkers are associated with poor prognosis in patients with CLL
Del(17p)
<10%
prevalence at diagnosis
TP53 mutation
3.2%
-6.8%
prevalence at diagnosis
IGHV unmutated
40%
prevalence at diagnosis
Complex karyotype
15%
prevalence at diagnosis
For patients with CLL in which treatment is indicated, the presence or absence of del(17p) and TP53 mutations are often used to direct treatment selection Biomarker Make sure to ask your doctor about testing for these high-risk factors prior to starting treatment:
Click each step to learn more
- IgHV is a gene that affects how immune cells make antibodies. When it is mutated, the cancer often grows more slowly, and when it is unmutated, the cancer may behave more aggressively
- in up to 50% of patients newly diagnosed with CLL, IgHV is unmutated, which means certain treatments may be less effective
- A standard blood draw for DNA sequencing determines this mutation
- This test is usually performed before the first treatment is started. The result almost never changes over time, so retesting is not necessary
- 11q deletion means a small part of chromosome 11 is missing, including genes that help repair DNA and control cell growth. When these genes are affected, CLL cells may grow more quickly or be harder to treat
- 20% of patients newly diagnosed with CLL will have an 11q deletion mutation
- FISH (fluorescence in situ hybridization) testing is used to test for 11q deletion
- Testing for this mutation should be performed prior to the start of each new treatment
- TP53 is a gene that helps keep cell growth under control and prevents damaged cells from multiplying
- A TP53 mutation means the gene is present but has an abnormal change that affects how it works
- 13% of patients newly diagnosed with CLL will have this mutation
- A standard blood draw for DNA sequencing determines this mutation
- Testing for this mutation should be performed prior to the start of each new treatment
- 17p deletion means cancer cells have lost a key piece of chromosome 17 that helps keep cell growth in check, making the cancer harder to control
- ~10% of patients newly diagnosed with CLL will have a 17p deletion mutation
- FISH (fluorescence in situ hybridization) Testing is used to test for 17p deletion
- Testing for this mutation should be performed prior to the start of each new treatment
- This is when 3 or more unrelated defects in chromosomes occur in more than one cell
- A standard blood draw or a bone marrow aspiration and biopsy determines occurrence
Which Option Aligns With Me?
BTK (Bruton’s tyrosine kinase) inhibitors
(known as a targeted therapy)
- Continuous treatment means you take one type of oral medication to continuously treat your cancer. This medicine is taken every day at home
- This medication is taken until it no longer works to treat your disease
- Side effects are generally manageable
- Fixed duration means you take multiple medications for a certain period of time. You may then experience a treatment-free period, after which treatment may be paused or adjusted depending on your response
- This medication is taken until it no longer works to treat your disease
- Fixed duration treatments may require several visits during the beginning of treatment, regular trips to the clinic for infusions, and potential hospitalization for observation, which is usually defined by having a large number of lymphocytes or large lymph nodes.
- Side effects are generally manageable, but when taking multiple medications, there is an increased risk that you may experience more side effects that vary in severity
BCL-2 (B-cell lymphoma 2) inhibitors + anti-CD20 monoclonal antibody
(known as a targeted therapy)
BCL-2 inhibitor + BTK inhibitor
(known as a targeted therapy)
Chemo-immunotherapy
(combines chemotherapy with monoclonal antibody immunotherapy)
Other less common treatment options may include chemotherapy, other targeted therapies, cellular therapy (such as CAR-T therapy), or a stem cell transplant.
Clinical Trials
In some cases, you and your doctor may decide that you may be a good candidate for a clinical trial (a research study to evaluate the safety and efficacy of a potential new medicine).
Please visit Clinical Trials FAQs to learn more.
Whether you can take a break from treatment is a conversation you will need to have with your doctor.
If you are on a fixed duration therapy, your doctor may want to test you for “measurable residual disease” (MRD). MRD is tested to see if cancer cells remain in your body after treatment, even when in remission. How MRD results are used in clinical decision making varies depending on the treatment regimen that was studied. Consult your doctor or care team when discussing fixed duration regimens.
If you are on a continuous treatment, you will typically remain on treatment if you are responding well and aren’t having any serious side effects. Stopping treatment is generally not recommended because it may cause your disease to progress.
Always consult with your doctor and with your care team about what is right for your treatment and to discuss any issues you are experiencing with your medications.
Your overall lifestyle may impact what treatment works best for you. Talk to your doctor about the option that best aligns to your personal situation.
Fixed Duration Treatment
Continuous Treatment
Treatment Considerations
Fixed Duration Treatment
Continuous Treatment
Additional premedication requirements prior to treatment initiation
Depending on the chosen treatment plan, additional medications may be required before starting treatment
Not required
Dosing ramp-up period
Initiating a fixed-duration treatment plan involves a more complex regimen and requires a
TLS (tumor lysis syndrome) risk assessment
Not required
TLS monitoring and blood work
Depending on how much cancer is in your body at the start of treatment, up to 19 blood tests may be required as you begin treatment and you may need multiple office visits and continuous monitoring.
Not required
Hospitalization
(for some patients)
Depending on how much cancer is in your body at the start of treatment and your risk of TLS, in-hospital monitoring may be required at the start of treatment
Not required
Significant time investment
Depending on your risk of TLS, ~50 to 134 hours for monitoring and blood work and 9+ office visits may be required in addition to the time you will spend taking your selected treatment
Not required
Treatment choice should fit your lifestyle
When comparing treatment options, consider:
- How much time you'll spend at appointments, infusions, and under monitoring
- How easy it is to stick to your treatment schedule
- How your plan fits with your energy, independence, and social life
- How your mental health may be impacted
- How your age and overall fitness level can impact which treatment works best for you
Talk to your doctor about which treatment is appropriate for your lifestyle.
Topics to Discuss Before Starting Treatment
Use this guide to help you talk with your doctor about available treatment options
When evaluating treatment options, come prepared with questions to ask your doctor
