Biological therapy for chronic lymphocytic leukaemia (CLL)

Men and women discussing chronic lymphocytic leukaemia

This page is about biological therapy for chronic lymphocytic leukaemia (CLL). There is information about

A quick guide to what's on this page
What biological therapy is
Monoclonal antibody treatment for CLL
Where to find more information

Biological therapy for chronic lymphocytic leukaemia (CLL)

Biological therapy is treatment with substances that are made naturally in the body or change the way that particular substances work in the body. Doctors use a type of biological therapy called monoclonal antibodies (MAB's) for CLL.

The main biological therapies used for CLL are rituximab and alemtuzumab.

Rituximab (Rituxan)

Rituximab works by seeking out a protein that is found on normal and leukaemic white blood cells (lymphocytes). Once it has found the lymphocytes, it sticks to them. The immune system then targets the cells and kills them. Normal lymphocytes then grow to replace those that are destroyed. Rituximab, in combination with fludarabine and cyclophosphamide chemotherapy, is now the first treatment used for most physically fit people with CLL. The most common side effect of rituximab is a reaction to the drug when you first have it.

Alemtuzumab (Mabcampath)

Alemtuzumab works by finding and attaching itself to the cancerous white blood cells (lymphocytes) and then killing them. You are most likely to have alemtuzumab if your CLL has stopped responding to chemotherapy. But alemtuzumab may sometimes be useful as a first treatment for physically fit people with CLL. Alemtuzumab can lower your resistance to infection. To help protect you against infection while you are having this drug, your doctor will give you antibiotics to take.

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Biological therapy is treatment with substances that are made naturally in the body or that change the way particular substances work in the body. We can now make some of these artificially.

Types of biological therapy called monoclonal antibodies (MABS) can be used to treat CLL. An antibody is a protein that is attracted to a particular type of cell. Monoclonal antibodies are multiple copies of an individual antibody. Those used for CLL may disrupt the leukaemia cell processes so that the cell stops dividing or dies. Or the MABs may stick to the leukaemia cells and trigger the immune system to destroy them.

The main monoclonal antibodies used to treat CLL are

Rituximab (Rituxan)
Alemtuzumab (Mabcampath)

Rituximab (Rituxan)

Rituximab is a type of biological therapy called a monoclonal antibody. Rituximab works by seeking out a protein called CD20 found on normal and leukaemic white blood cells (lymphocytes). Once it has found the lymphocytes, it sticks to them and the immune system then targets the cells and kills them. Normal lymphocytes then grow to replace those that are destroyed.

Rituximab, in combination with the chemotherapy drugs, fludarabine and cyclophosphamide is the most commonly used first line treatment for people with CLL who are physically fit. Rituximab has some side effects. You are most likely to have side effects when you first have the drug. You may have one or more of the following

Fever, chills and shivering
Feeling sick
An itchy rash
A headache

A few people have wheezing and feel faint because their blood pressure goes down. You are most likely to have one or more of these side effects in the first 2 hours after having the drug. Your doctor may prescribe drugs to try and prevent them (an antihistamine and a steroid). If you do have a reaction, your nurse may slow down your rituximab drip to help control it.

Alemtuzumab (Campath 1H)

Alemtuzumab is also called Mabcampath, Campath, or Campath 1H. You are most likely to have alemtuzumab if your CLL has stopped responding to chemotherapy or has come back after chemotherapy treatment. But alemtuzumab may sometimes be useful as a first treatment for physically fit people with CLL. You may have alemtuzumab with a steroid (methylprednisolone) if your CLL is found to have a change (mutation) in the p53 gene.

Alemtuzumab works best in patients with CLL who don't have a lot of very enlarged lymph nodes. It works by finding and attaching itself to the cancerous white blood cells (lymphocytes) and then killing them.

You usually have alemtuzumab through a drip into a vein. But it can also be given as an injection just under the skin (subcutaneously). Doctors have found that it causes fewer side effects this way. Trials are checking that it works as well when given under the skin as it does when given into a vein. When you have it under the skin you have the treatment as an outpatient instead of having to stay in hospital for a few days to have the drip.

Alemtuzumab has some side effects. The most important one is that it can lower your resistance to infection. Your doctor will give you antibiotics to take while you are on this drug, to help protect you against infection. If you think you are getting an infection, you should let the hospital know as soon as possible.

Other side effects are usually mild and settle down during your course of treatment. They include

You can read more about the immune system elsewhere in CancerHelp UK. There is information about the different types of biological therapies, including monoclonal antibodies in the cancer treatment section. There is more about alemtuzumab and rituximab for CLL in the section on chronic lymphocytic leukaemia research in this section of CancerHelp UK.

Other biological therapy drugs being used in trials for CLL include lenalidomide (Revlimid) and ofatumumab. You can also find information about them on our CLL research page.