When I was first diagnosed with chronic lymphocytic leukemia (CLL) more than 20 years ago, the treatment landscape looked very different than it does today. At that time, one of the most common treatment approaches was chemoimmunotherapy, often called CIT1,2.
Over the past decade, significant advances in CLL/SLL research have led to the development of new treatment options that have changed how many patients are treated today. Understanding the role of chemoimmunotherapy in CLL/SLL today can help you have more informed conversations with your healthcare team about your treatment options.
What Is Chemoimmunotherapy?
Chemoimmunotherapy is a treatment approach that combines two different strategies1,2:
- Chemotherapy, which works by killing fast-growing cells
- Immunotherapy, which helps the immune system recognize and attack cancer cells
The treatments are typically administered intravenously (through an IV) and were an important part of CLL/SLL care for many years1,2.
Why Has the Treatment Landscape Changed?
As researchers learned more about the biology of CLL/SLL, they discovered specific pathways and signals that help CLL/SLL cells survive and grow1,2. This knowledge led to the development of a newer category of medicines known as targeted therapies1,2.
Unlike chemoimmunotherapy, targeted therapies are designed to focus on specific mechanisms that CLL/SLL cells depend on1,2. Today, two major classes of targeted therapies used to treat CLL/SLL—Bruton’s Tyrosine Kinase Inhibitors (BTKis) and BCL-2 Inhibitors (BCL-2is)—have largely replaced CIT1,2.
How Does Chemoimmunotherapy Compare to Newer Treatments?
For many patients, newer targeted therapies have largely replaced chemoimmunotherapy2. CLL/SLL clinical trials have shown that BTKi and BCL-2i-based therapies often provide longer disease control than CIT and may have different safety considerations1,2. Additionally, many of the targeted therapies are taken by mouth, offering a different treatment experience than traditional IV-based chemoimmunotherapy1,2.
This shift reflects a broader goal in CLL/SLL care: finding treatments that can effectively control the disease while reducing some of the challenges associated with older approaches.
Looking Beyond Immediate Treatment
Because CLL/SLL is considered a chronic disease, it’s important to think not only about how a treatment works today, but also about its potential long-term effects. This is one of several reasons why healthcare teams may consider long-term outcomes when discussing CLL/SLL treatment options.
When discussing treatment options with your healthcare team, you may want to ask questions about:
- Long-term outcomes
- Potential side effects
- How treatment could affect your quality of life
- What research has shown over many years of follow-up
Understanding both the benefits and risks of a treatment can help you and your healthcare team make decisions that align with your personal goals and priorities.
A Final Thought from Dr. Brian Koffman
The treatment of CLL/SLL has come a long way. What was once considered standard care has evolved alongside our growing understanding of the disease. Today, people living with CLL/SLL have more treatment options than ever before, and research continues to advance the field.
If you have questions about CLL/SLL treatment options, be sure to discuss them with your healthcare team. Together, you can evaluate the available information and determine the approach that’s right for you.
About the Author
Dr. Brian Koffman is a retired physician, professor, and internationally recognized patient advocate. He is the co-founder and Chief Medical Officer Emeritus of CLL Society – a nonprofit organization dedicated to addressing the unmet needs of the Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) community.
Throughout his career, Dr. Koffman has championed patient-centered care in hematologic malignancies, with leadership spanning clinical practice, medical education, and global patient advocacy. He is a trusted thought partner across academia, industry, and nonprofit organizations.
As both a retired physician and an individual who has lived with CLL for more than two decades, Dr. Koffman brings a unique perspective that combines deep scientific expertise with firsthand patient experience. This rare combination has made him one of the most respected and influential voices in the global CLL/SLL community.
Dr. Koffman currently serves on the Board of Directors of CLL Society.
References
- Burger JA. Treatment of chronic lymphocytic leukemia. N Engl J Med. 2020;383(5):460-473. doi:10.1056/NEJMra1908213
- Davids MS, Stilgenbauer S, Tam CS. First-line treatment for CLL in the era of targeted therapy. Blood Cancer J. 2026;16(1):19. doi:10.1038/s41408-025-01434-2
- Ailawadhi S, Ravelo A, Ng CD, et al. Assessment of second primary malignancies among treated and untreated patients with chronic lymphocytic leukemia using real-world data from the USA. J Comp Eff Res. 2024;13(2):e230119. doi:10.57264/cer-2023-0119
