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Chemotherapy and Drug Therapy

People who have symptomatic intermediate- and high-risk (faster-growing) chronic lymphocytic leukemia (CLL) are usually treated with chemotherapy and/or targeted drug therapy using monoclonal antibodies. Combining chemotherapy drugs with monoclonal antibodies is another effective way to treat CLL.

You may be given the drugs as pills to swallow, by injection or through a catheter (a thin, flexible tube or intravenous line) surgically placed in a vein, normally in your upper chest.

Given the importance of genetics in picking the correct therapy for CLL, it is important that FISH studies are done to look for del (17p) and del (11q) prior to starting treatment for CLL.


During chemotherapy, you'll be given potent drugs that must be toxic enough to damage or kill leukemic cells. At the same time, they take aim at normal cells and can cause side effects. Yet, not everyone experiences side effects and people react differently.

Doctors commonly combine two or more chemotherapy drugs to treat CLL. Each drug type works in a different way to kill the cancerous cells. Combining drug types can strengthen their effectiveness.

The chemotherapy drug fludarabine (Fludara®) is considered one of the most effective types of chemotherapy drugs for CLL. Other standard chemotherapy drugs that doctors use to treat CLL as a single agent or in combination include:

Monoclonal Antibody Therapy

Drug therapy using monoclonal antibodies can be an effective treatment. A monoclonal antibody is an immune protein made in a laboratory. It's designed to target a specific molecule on the surface of CLL cells. The monoclonal antibody aims for the molecule and attaches itself to the cell, causing the cell to die.

Monoclonal antibody therapies can cause side effects, but they're generally milder than chemotherapy's side effects. Because they're designed to target and attack specific substances, they tend to leave normal cells unharmed.

Monoclonal antibodies, some of which are being studied in clinical trials, used to treat CLL are:

Doctors sometimes combine chemotherapy drugs and monoclonal antibodies to treat people with CLL. One combination for newly diagnosed patients who have not been treated is ofatumumab (Arzerra) in combination with chlorambucil. This is for patients for whom fludarabine-based therapy is considered inappropriate.

Studies show that fludarabine, when combined with another chemotherapy drug or monoclonal antibody, significantly improves the frequency of complete responses in people being treated for CLL for the first time. Common fludarabine drug combinations - often used to treat patients with intermediate- and high-risk CLL - include:

  • FC- (fludarabine and cyclophosphamide)
  • FR- (fludarabine and rituximab)
  • FCR- (fludarabine, rituximab and cyclophosphamide)

Studies comparing treatment with chemotherapy (fludarabine or FC) with chemoimmunotherapy (FR or FCR) have shown that FR or FCR treatment significantly improve the frequency of complete response, remission duration, and overall survival in previously untreated people with CLL.

Bendamustine combined with other drugs is being studied in clinical trials to treat people with CLL. Combinations include:

  • bendamustine and rituximab

If you would like to read about these drugs individually, including information about side effects, click here.

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last updated on Tuesday, April 22, 2014

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