Treatments for CLL

How is CLL treated?

CLL is generally very treatable, but you might not need treatment straight away. Some people don’t need treatment for a long time and some people never need treatment. If you don’t need treatment straight away, your haematology team will monitor you instead. This is called active monitoring or ‘watch and wait’.

CLL rarely needs urgent treatment because it is usually very slow-growing. If you need treatment, it can be effective. Treatments aim to keep CLL under control for as long as possible, rather than to cure it.

The usual treatments for CLL are:

• Targeted medicines
• Antibody therapies

You may need several different types of treatment during your illness. You are likely to have long periods of feeling well between courses of treatment.

Treatment options for CLL

Most people have a targeted medicine as treatment for CLL. Some people have an antibody therapy alongside a targeted medicine.

If you need treatment, your haematology team will work out which treatment is best for you based on:

• Your preferences
• Your age and general health, including other health conditions you may have
• The stage of your CLL, how it is affecting you and the particular genetic changes in your CLL cells
• Side effects of treatment that might affect you
• Any previous treatment you’ve had, how well you responded to it and how it affected you

Targeted medicines

These medicines target proteins on your CLL cells to kill the cells. They are generally very effective at keeping CLL under control.

Targeted medicines are tablets or capsules that you take by mouth at home. These are the main targeted medicines used to treat CLL:

• Zanubrutinib
• Ibrutinib
• Acalabrutinib
• Venetoclax
• Venetoclax with ibrutinib

Antibody therapies

You might have an antibody therapy alongside a targeted medicine. Antibody therapies are antibodies made in a lab. They trigger your immune system to destroy CLL cells.

You usually have antibody therapy in the hospital as an outpatient. You’ll have it through a drip into a vein.

These are the main combinations of targeted medicine and antibody therapy used to treat CLL:

• Venetoclax with obinutuzumab
• Venetoclax with rituximab (this combination is only suitable if you’ve already had at least one other treatment for CLL)

Other treatment options

You may have treatments other than targeted medicines or antibody therapies. It depends on your symptoms, stage of CLL and medical history. Your haematology team will tell you what they recommend for you.

Stem cell transplant

A stem cell transplant replaces damaged or destroyed blood-forming cells with healthy ones. Stem cells are the cells in your bone marrow that make new blood cells.

Rarely, you might be offered a stem cell transplant if you have a very aggressive form of CLL that hasn’t responded to other treatments. A stem cell transplant is an intensive treatment so you must be fit enough to cope with it.

A stem cell transplant starts with chemotherapy to kill as many CLL cells as possible. This also kills your stem cells. You have a stem cell transplant to replace them with healthy stem cells. These are from a matched donor.

The donor stem cells develop into new white blood cells that gradually replace your immune system. Your new immune system can help recognise and attack any CLL cells left in your body.

If your team recommend a stem cell transplant, they will explain the risks and benefits.

Clinical trials

Your doctor may ask if you’d like to take part in a clinical trial. These are research studies to find out what treatments work best for people with CLL.

Clinical trials might test:

• New medicines
• New ways to use existing medicines, such as different combinations or doses

Your haematology team should explain the risks and benefits of taking part. It is completely up to you whether you’d like to take part and you can withdraw from a trial at any time.

Supportive care

You might have treatments to help relieve your symptoms or to stop infections. You have supportive care alongside treatments to control your CLL.

Supportive care can include:

• Medicines to prevent or treat infections, such as an antibiotic, antifungal or antiviral medicine
• Medicine to increase your antibody levels, called immunoglobulin replacement therapy
• Vaccinations such as flu, shingles, and COVID
• Medicine to boost your white blood cell count called growth factor (G-CSF)
• Transfusions to treat low blood cell counts, such as red blood cell transfusions or platelet transfusions

Hear other people’s experiences

It can be helpful to hear about people who’ve been in a similar situation to you. Our inspirational stories are personal accounts from people affected by blood cancer. They share their experiences, feelings or practical tips that helped them cope. Choose ‘chronic lymphocytic leukaemia (CLL)’ in the dropdown list to find stories from people affected by CLL.

Sources we used to develop this information

AbbVie Ltd. Venclyxto (venetoclax) 10 mg film-coated tablets – Summary of product characteristics. 20 February 2025. Available at: https://www.medicines.org.uk/emc/product/2267/smpc  

AbbVie Ltd. Venclyxto (venetoclax) 100 mg film-coated tablets – Summary of product characteristics. 26 February 2025. Available at: https://www.medicines.org.uk/emc/product/10476/smpc  

AbbVie Ltd. Venclyxto (venetoclax) 50 mg film-coated tablets – Summary of product characteristics. 26 February 2025. Available at: https://www.medicines.org.uk/emc/product/10475/smpc  

AbbVie Ltd. Venclyxto (venetoclax): 10 mg, 50mg, 100mg film-coated tablets. Package leaflet: information for the patient. January 2025. Available at: https://www.medicines.org.uk/emc/product/2267/pil  

AstraZeneneca UK Limited. Calquence (acalabrutinib maleate) 100 mg film-coated tablets. Summary of product characteristics. 08 December 2023. Available at: https://www.medicines.org.uk/emc/product/14853/smpc  

AstraZeneneca UK Limited. Calquence (acalabrutinib maleate) 100 mg film-coated tablets. Patient information leaflet. 13 October 2023. Available at: https://www.medicines.org.uk/emc/product/14853/pil  

Beigene UK Limited. Brukinska (zanubrutinib) 80 mg hard capsules – Summary of product characteristics. 05 December 2024. Available at: https://www.medicines.org.uk/emc/product/14001/smpc  

Beigene UK Limited. Brukinska (zanubrutinib) 80 mg hard capsules. Package leaflet: information for the patient. October 2024. Available at: https://www.medicines.org.uk/emc/product/14001/pil  

Bennett R, Seymour JF. Update on the management of relapsed/refractory chronic lymphocytic leukemia. Blood Cancer J, 2024, 14(1): 33. https://doi.org/10.1038/s41408-024-01001-1https://doi.org/10.1038/s41408-024-01001-1  

Celltrion Healthcare UK Limited. Truxima (rituximab) 100 mg concentrate for solution for infusion – Summary of product characteristics. 23 Mar 2025. Available at: https://www.medicines.org.uk/emc/product/8878/smpc  

Celltrion Healthcare UK Limited. Truxima (rituximab) 500 mg concentrate for solution for infusion – Summary of product characteristics. 14 Mar 2025. Available at: https://www.medicines.org.uk/emc/product/9701/smpc  

Eichhorst B, Robak T, Montserrat E, Ghia P, Niemann CU, Kater AP, et al.; ESMO Guidelines Committee. Chronic lymphocytic leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and followup. Ann Oncol. 2021 Jan;32(1):23–33. https://doi.org/10.1016/j.annonc.2020.09.019  

Janssen-Cilag Ltd. Imbruvica (ibrutinib) 140 mg film-coated tablets – Summary of product characteristics. 20 September 2024. Available at: https://www.medicines.org.uk/emc/product/10025/smpc  

Janssen-Cilag Ltd. Imbruvica (ibrutinib) 280 mg film-coated tablets – Summary of product characteristics. 20 September 2024. Available at: https://www.medicines.org.uk/emc/product/10039/smpc  

Janssen-Cilag Ltd. Imbruvica (ibrutinib) 420 mg film-coated tablets – Summary of product characteristics. 24 September 2024. Available at: https://www.medicines.org.uk/emc/product/10040/smpc  

Janssen-Cilag Ltd. Imbruvica (ibrutinib) 560 mg film-coated tablets – Summary of product characteristics. 24 September 2024. Available at: https://www.medicines.org.uk/emc/product/10041/smpc  

Janssen-Cilag Ltd. Imbruvica (ibrutinib): 140 mg, 280 mg, 420 mg, 560 mg film-coated tablets. Package leaflet: information for the patient. August 2024. Available at: https://www.medicines.org.uk/emc/product/10041/pil  

Molica S, Tam C, Allsup D, et al. Advancements in the Treatment of CLL: The Rise of Zanubrutinib as a Preferred Therapeutic Option. Cancers, 2023. 15: 3737. https://doi.org/10.3390/cancers15143737  

National Institute for Health and Care Excellence (NICE). Acalabrutinib for treating chronic lymphocytic leukaemia. Technology appraisal guidance [TA931] Published: 21 April 2021. Available at: https://www.nice.org.uk/guidance/ta689  

National Institute for Health and Care Excellence (NICE). Ibrutinib for previously treated chronic lymphocytic leukaemia and untreated chronic lymphocytic leukaemia with 17p deletion or TP53 mutation. 2017. Technology appraisal guidance [TA429] Published: 25 January 2017. Available at: https://www.nice.org.uk/guidance/ta429  

National Institute for Health and Care Excellence (NICE). Ibrutinib with venetoclax for untreated chronic lymphocytic leukaemia. 2023. Technology appraisal guidance [TA891] Published: 31 May 2023. Available at: https://www.nice.org.uk/guidance/ta891/  

National Institute for Health and Care Excellence (NICE). Venetoclax for treating chronic lymphocytic leukaemia. 2022. Technology appraisal guidance [TA796] Published: 15 June 2022. Available at: https://www.nice.org.uk/guidance/ta891/  

National Institute for Health and Care Excellence (NICE). Venetoclax with obinutuzumab for untreated chronic lymphocytic leukaemia. 2020. Technology appraisal guidance [TA931] Published: 9 December 2020. Available at: https://www.nice.org.uk/guidance/ta663/    

National Institute for Health and Care Excellence (NICE). Venetoclax with rituximab for previously treated chronic lymphocytic leukaemia. 2019. Technology appraisal guidance [TA561] Published: 27 February 2019. Available at: https://www.nice.org.uk/guidance/ta561/  

National Institute for Health and Care Excellence (NICE). Zanubrutinib for treating chronic lymphocytic leukaemia.  2023. Technology appraisal guidance [TA931] Published: 22 November 2023. Available at: https://www.nice.org.uk/guidance/ta931   

Pfizer Limited. Ruxience 100 mg concentrate for solution for infusion – Summary of product characteristics. 01 Apr 2025. Available at: https://www.medicines.org.uk/emc/product/11792/smpc  

Pfizer Limited. Ruxience 500 mg concentrate for solution for infusion – Summary of product characteristics. 01 Apr 2025. Available at: https://www.medicines.org.uk/emc/product/11793/smpc  

Roche Products Limited. Gazyvara 1,000mg concentrate for solution for infusion – Summary of product characteristics. 11 April 2025. Available at: https://www.medicines.org.uk/emc/product/3279/smpc  

Roche Products Limited. MabThera 100 mg concentrate for solution for infusion – Summary of product characteristics. 16 July 2024. Available at: https://www.medicines.org.uk/emc/product/3801/smpc  

Roche Products Limited. MabThera 500 mg concentrate for solution for infusion – Summary of product characteristics. 16 July 2024. Available at: https://www.medicines.org.uk/emc/product/793/smpc  

Rotbain EC, Niemann CU, Rostgaard K, et al. Mapping comorbidity in chronic lymphocytic leukemia: impact of individual comorbidities on treatment, mortality, and causes of death. Leukemia, 2021. 35(9): 2570–2580. https://doi.org/10.1038/s41375-021-01156-x  

Sandoz Limited. Rixathon 100 mg concentrate for solution for infusion – Summary of product characteristics. 06 February 2025. Available at: https://www.medicines.org.uk/emc/product/2714/smpc  

Sandoz Limited. Rixathon 500 mg concentrate for solution for infusion – Summary of product characteristics. 07 February 2025. Available at: https://www.medicines.org.uk/emc/product/10322/smpc  

Scottish Medicines Consortium (SMC). Venetoclax (Venclyxto) [SMC 2293]. 6 November 2020. Available at: https://scottishmedicines.org.uk/medicines-advice/venetoclax-venclyxto-full-smc2293/  

Scottish Medicines Consortium (SMC). Venetoclax (Venclyxto) [SMC 2427]. 8 April 2022. Available at: https://scottishmedicines.org.uk/medicines-advice/venetoclax-venclyxto-full-smc2427/  

Shadman M. Diagnosis and Treatment of Chronic Lymphocytic Leukemia: A Review. JAMA, 2023. 329(11): 918–932. https://doi.org/10.1001/jama.2023.1946  

Tam C, Thompson PA. BTK inhibitors in CLL: second-generation drugs and beyond. Blood Adv. 2024 May 14;8(9):2300-2309. https://doi.org/10.1182/bloodadvances.2023012221  

Waleswska R, Parry-Jones N, Eyre TA, et al. Guideline for the treatment of chronic lymphocytic leukaemia. Br J Haematol, 2022. 197: 544–557. https://doi.org/10.1111/bjh.18075  

Wang X, Kokabee L, Kokabee M, Conklin DS. Bruton’s Tyrosine Kinase and Its Isoforms in Cancer. Front Cell Dev Biol. 2021 Jul 8;9:668996. https://doi.org/10.3389/fcell.2021