How you have targeted drugs and chemotherapy for CLL

This page is about how you have chemotherapy and targeted cancer drugs for chronic lymphocytic leukaemia (CLL).

There are different types of targeted drugs and chemotherapy for CLL. You have them in different ways.

Most people have treatment for CLL as an outpatient.

Treatment can be:

  • tablets
  • an injection into a vein as a drip (intravenously)

You have treatment in cycles or blocks. Each cycle usually lasts for 28 days. You have some drugs every day and others weekly or less often. After each cycle of treatment, your team will check your side effects. They will also check how well treatment is working.

You might have up to 6 cycles of treatment. But some treatments carry on until they stop working or side effects become too severe.

You can read more about each drug in our cancer treatment section.

Having treatment

There are many different drugs for treating CLL. You might have these on their own or in a combination. The 4 main treatments are:

  • either ibrutinib or acalabrutinib (these drugs are called bruton tyrosine kinase Inhibitors (BTKi) and you take them on their own)
  • venetoclax with either rituximab or obinutuzumab
  • chemotherapy with immunotherapy (chemoimmunotherapy)
  • idelalisib with rituximab

You might have one of these drugs.

Acalabrutinib

You take acalabrutinib as tablets twice every day. You usually carry on taking acalabrutinib if it is controlling the growth of your CLL. And if your side effects are not too severe.

Ibrutinib

You take ibrutinib as tablets every day. You usually carry on taking ibrutinib if it is controlling the growth of your CLL. And if your side effects are not too severe.

You take venetoclax as tablets. You take it with either rituximab or obinutuzumab. You have rituximab and obinutuzumab as a drip into your bloodstream.

You have it as cycles of treatment. Each cycle lasts 28 days. 

Venetoclax and rituximab

You start by taking venetoclax on its own and slowly increase the dose over 5 weeks. You then have venetoclax and rituximab as cycles of treatment. You have rituximab on day 1 of each cycle. You take venetoxlax every day.

Most people have up to 6 cycles of rituximab treatment. You can carry on taking venetoclax on its own for up to 2 years.

Venetoclax and obinutuzumab

You have obinutuzumab on days 1, 2, 8, and 15 of the first cycle. 

You then start taking a low dose of venetoclax on day 22 of the first cycle. You take it every day.

You have 5 more cycles of venetoclax and obinutuzumab. You have obinutuzumab on day 1 of each cycle. You take venetoclax every day and slowly increase the dose during the second cycle.

You then carry on taking venetoclax on its own for up to 6 months. 

You might have:

Fludarabine, cyclophosphamide and rituximab (FCR)

You usually have these drugs as both tablets and a drip into your bloodstream. Or you may just have all the drugs as a drip into your bloodstream. 

You have FCR as cycles of treatment. Each cycle lasts 28 days. You usually have treatment on the first few days of week 1. You then have no treatment for the rest of the cycle. And then you start cycle 2 of treatment.

Most people have up to 6 cycles of treatment.

Bendamustine and rituximab (BR)

You have these drugs as a drip into your bloodstream. 

You have BR as cycles of treatment. Each cycle lasts 28 days. You usually have treatment on the first 2 days of week 1. You then have no treatment for the rest of the cycle. And then you start cycle 2 of treatment.

Most people have up to 6 cycles of treatment.

Chlorambucil with or without obinutuzumab

You take chlorambucil as tablets. You have obinutuzumab as a drip into your bloodstream.

You have cycles of treatment. Each cycle lasts 28 days. 

You have obinutuzumab on day 1, 8, and 15 of the first cycle. After that you only have it on day 1 of each cycle. You have chlorambucil on day 1 and 15 of each cycle.

Most people have up to 6 cycles of treatment.

You might have chlorambucil on its own without obinutuzumab. You take it every day for 1 or 2 weeks and then have no treatment for the rest of the cycle. Or you might take it every day.

You take idelalisib as tablets. You have rituximab as a drip into your bloodstream.

You have idelalisib and rituximab as cycles of treatment. Each cycle lasts 28 days. You have rituximab on day 1 and 15 of the first 2 cycles. After that you only have it on day 1 of each cycle. You take idelalisib on every day.

Most people have up to 6 cycles of treatment.

Supportive treatments

CLL and its treatment can cause problems. Supportive treatments can help to prevent some of these problems.  

The problems you might develop depend on how the CLL is affecting your body. And it also depends on what treatment you have.

Preventing tumour lysis syndrome

When cancer drugs kill leukaemia cells, the body breaks down the dead cells. This releases chemicals into your blood. So the normal balance of chemicals circulating in your blood suddenly changes. This is called tumour lysis syndrome.

You have regular blood tests to check for this if you are at risk. You might need to take medicines called rasbirucase or allopurinol to help prevent tumour lysis syndrome. It’s also important to drink plenty of fluids.

Preventing infection

Your doctor might suggest you take medicines to reduce the risk of getting infection. These include medicines to prevent:

  • bacterial infections - for example, you might take an antibiotic called co-trimoxazole
  • viral infections - for example, you might take an anti viral drug called aciclovir

Taking your tablets or capsules

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

Treatment into the bloodstream

When you have treatment into your bloodstream you usually go to the hospital or a day unit. You can usually go home the same day.

Depending on the drug, you may have your treatment by injection through a small needle (cannula) into a vein over a few minutes. 

Diagram showing a cannula

Some people have treatment through a drip over a longer period. Before each treatment you have a blood test to check your white blood cell, red blood cell and platelet counts.

Side effects

Many people are worried about the possible side effects of treatment. All treatments cause some side effects. But side effects vary from one person to another.

Side effects depend on what treatment you have. There are several types of drug treatments for CLL. These have different side effects.  You can look up your treatment drugs on our cancer drug list and read about the side effects.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Dietary or herbal supplements

We don't know enough about how some nutritional or herbal supplements may interact with cancer drugs. Some could be harmful.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. Let your doctors know if you:

  • take any supplements
  • have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.

Information and support

You can contact our Cancer Information Nurses on 0808 800 4040 Monday to Friday, 9am to 5pm, with any questions you might have about having treatment for CLL.
Last reviewed: 
10 Sep 2021
Next review due: 
10 Sep 2024
  • Guideline for the treatment of chronic lymphocytic leukaemia - A British Society for Haematology Guideline
    A Schuh and others
    British Journal of Haematology 2018,  Volume182, Issue 3, Pages 344 – 359

  • Chronic lymphocytic leukemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up
    B Eichorst and others.
    Annals of Oncology, 2021, Volume 32  Issue 1 pages 22-33

  • Electronic Medicines Compendium 
    Accessed April 2021

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