Treatment of Recurrent Chronic Lymphocytic Leukemia

This content has been reviewed and approved by

Hagop M. Kantarjian, MD
Chairman & Professor, Leukemia Department
MD Anderson Cancer Center
University of Texas

Recurrent chronic lymphocytic leukemia (CLL) remains highly responsive to a variety of treatments and patients may survive for many years with repeated treatment.

A wide range of retreatment options exist for recurrent CLL patients. Currently, available standard treatment options for recurrent CLL patients includes the following:

• Campath^® (alemtuzumab) - This drug stimulates the immune system to attack and kill the cancerous lymphocytes, sparing most healthy cells in the body from destruction. It is approved by the U.S. Food and Drug Administration for treating CLL after progression on fludarabine regimens.
• Single-agent chemotherapy with Fludara^® (fludarabine phosphate) - As a second treatment, Fludara induces complete remission in approximately 10 to 15 percent of patients.
• Retreatment with combination chemotherapy - These include Fludara^®, rituximab, and cyclophosphamide (FCR) or other chemotherapy regimens with anthracyclines (CHOP-R, hyper CVAD-R) or ones used in lymphoma.
• New drugs - These include Revlimid^® (lenalidomide) or new phase 1 and 2 studies. A new drug, called bendamustine, is an alkylating agent that is active in CLL and lymphoma. It is approved for use in Europe. It may be approved for use in the United States at later time.
• Radiation - Radiation therapy may be used to treat involved lymph nodes that are not responding to systemic therapy or to rapidly control expanding lymph nodes that interfere with organ function.
  
• Splenectomy
• Stem cell transplant - High-dose chemotherapy and autologous or allogeneic stem cell transplantation as treatment for relapsed CLL has been evaluated. Delivery of high-dose chemotherapy and allogeneic stem cell transplantation has been associated with significant side effects, with 20 percent to 40 percent of patients dying from complications of treatment within 2 years of transplantation. However, 40 percent to 60 percent of patients survive without evidence of recurrent cancer 3 or more years from receiving high-dose chemotherapy. These results are very encouraging and suggest that patients with CLL may be curable.
  
  

  Research is in progress to refine existing treatments and develop new ones. For information on some of the techniques currently under investigation, see Strategies to Improve Treatment.