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Treatment decisions

Information about how your doctor decides which treatment you need and treatment by stage.

The main treatments

When your doctors are deciding on the best treatment for you they will look at:

  • how far your leukaemia has developed (the stage)
  • your general health
  • your age and level of fitness

You may not need treatment straight away if you have very early stage CLL and you don't have symptoms. If you need treatment, you will have chemotherapy. You may also have radiotherapy. 

If your CLL is more advanced or has come back after earlier treatment, you may have chemotherapy with biological therapy.

A small number of people may have intensive treatment, which means chemotherapy with a bone marrow or stem cell transplant.

Early stages

Many people have no symptoms when they are first diagnosed. It may have been picked up on a routine blood test. If you have no symptoms, your specialist will probably suggest that you have no treatment for now.

CLL can develop very slowly. You might be older when diagnosed and so may never need treatment. Starting treatment when you have no symptoms is unlikely to help.

Your GP or haematologist will monitor you regularly and check your blood cell count. This is called watchful waiting.

You might start treatment for the following reasons, you have:

  • fast developing disease
  • bulky lymph nodes or spleen
  • bone marrow failure
  • tiredness (fatigue), severe weight loss, drenching night sweats

Your doctor will probably suggest chemotherapy. They may also recommend radiotherapy to shrink swollen lymph nodes, or surgery to remove a swollen spleen. 

The treatment will not get rid of CLL for good but can put it into remission. Remission means there is no sign of the leukaemia on scans or tests and you have no symptoms.

With early stage CLL a remission can last for years. After some time the leukaemia may become active again and cause symptoms. This is called a relapse.

Later stages

Later stage CLL includes stage B CLL with symptoms, or stage C CLL. If you have later stage, your doctor may suggest chemotherapy, perhaps combined with a biological therapy called rituximab.

The treatment may get your leukaemia under control (in remission). You may then have a period where you do not need any treatment. 

If the CLL comes back after treatment, your doctor may suggest more chemotherapy or they may suggest a biological therapy.

Many people with CLL can have further remissions with more treatment each time the leukaemia comes back. The remissions tend to get shorter, the more treatment you have.

If you have swollen lymph nodes your doctor may recommend radiotherapy to shrink them. If your spleen is swollen they may recommend surgery to remove the spleen.

Intensive treatment

A small number of people have intensive treatment with a bone marrow or stem cell transplant for CLL but this is still experimental. The intensive treatment aims to try to get rid of the CLL for good, or to control it for longer than standard treatments.

Before you can have this type of treatment, you will have tests to make sure that you are well enough to get through it. Intensive treatments are too risky if you are not fit enough.

If you are going to have intensive treatment, you will have chemotherapy first, to try to get your CLL into remission.

You then have a stem cell or bone marrow transplant. This means more chemotherapy and sometimes radiotherapy, followed by a drip (infusion) of donor bone marrow or blood stem cells.

Clinical trials

Researchers and doctors continue to look for better treatments or different treatment combinations for CLL. They test them in clinical trials. Your doctor may suggest that you join a trial.In our research section, there is information about clinical trials, including what it is like to take part.

Last reviewed: 
05 Mar 2015
  • Guidelines on the diagnosis, investigation and management of chronic lymphocytic leukaemia
    British Society for Haematology, 2012

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