How We Treat Chronic Lymphocytic Leukemia

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Our Treatment Approach

The Center for Chronic Lymphocytic Leukemia is part of Dana-Farber Brigham Cancer Center's Center for Hematologic Oncology, one of the world's largest and most respected treatment centers for patients with disorders of the blood or bone marrow.

Your care will involve the best treatments currently available, and may include therapies based on the discoveries made in our own laboratories or elsewhere in the field of CLL research. We carefully consider an array of clinical trials — the mainstay of our treatment approach — some of which are only available here and have been developed by our physician-scientists.

Multidisciplinary Team

Your care is coordinated by a world-class team of specialists — including medical oncologists, hematopathologists, lab scientists, nursing professionals, physician assistants, psychologists, clinical car coordinators, social workers, and nutritionists — with years of expertise in treating patients with CLL.

Our providers work together to coordinate fully integrated, personalized care, from your initial diagnosis through treatment at each stage, to try to keep ahead of the disease and offer the best possible outcomes.

Personalized Treatment

As a highly specialized Center within Dana-Farber Brigham Cancer Center's Center for Hematologic Oncology, the Center for Chronic Lymphocytic Leukemia focuses on the distinct needs of people with CLL. This enables us to provide a highly personalized approach to your care. In order to create the most effective treatment plan, your care team will adjust your therapy based on how you respond to a particular treatment.

We take time to involve you and your family in each step of the treatment process. As you go through treatment phases, you and your family will have access to a wide range of support resources — from nutrition services to integrative therapies.

For older patients, our team partners with a geriatrician to help manage CLL treatment alongside other health conditions that a patient may have.

Treatment Options for Chronic Lymphocytic Leukemia

Each patient's care involves careful consideration of the timing of treatment, standard therapies, novel drug combinations, and new therapies. As resistance arises, we re-evaluate our approach and shift treatment strategies as needed.

Treatment plans depend on:

The prognostic markers of the disease.
The stage of the disease.
Red blood cell, white blood cell, and platelet blood counts.
Whether there are signs or symptoms.
Whether the liver, spleen, or lymph nodes are larger than normal.
The response to initial treatment.
Whether the CLL has recurred (come back).

While treatment for CLL is usually not curative, most people live for many years with this disease. For many patients with early-stage CLL, immediate treatment is not necessary, though treatment will likely be needed when the disease progresses.

Treatments can include:

Active Surveillance

Patients who are not experiencing symptoms or who have a precursor condition may not need immediate treatment and can be monitored for disease progression. Research shows that it is not beneficial to start treatment right away in patients without symptoms, anemia, or thrombocytopenia. This is especially true since newer, more effective, or better tolerated drugs are continuously becoming available or accessible as first-line treatment.

For patients who require treatment, most patients are treated with targeted drug therapy. When treatment is needed, you may need a CT scan and/or a bone marrow biopsy.

Targeted Therapy

Targeted therapies are drugs that identify and attack specific cancer cells more than normal cells.

Monoclonal antibody therapy is a kind of targeted therapy treatment that uses antibodies made in the lab from a single type of immune system cell. These antibodies can identify molecules on cancer cells or normal substances in the body that may help cancer cells grow. A few examples of such antibodies are rituximab, and obinutuzumab.

Several oral targeted agents have also recently been approved for treatment of CLL. These include ibrutinib, idelalisib, venetoclax, acalabrutinib, and duvelisib.

View videos of our experts speaking about various CLL treatments:

Jennifer Brown, MD, PhD, on acalabrutinib versus Ibrutinib for CLL
Matthew Davids, MD, MMSC, on long-term follow-up of venetoclax in CLL
Inhye Ahn, MD, on ibrutinib for CLL

Cellular Therapies

We work closely with our hematopoietic Stem Cell Transplantation Program when CLL patients require bone marrow/stem cell transplant, usually in later stages of treatment. Our Stem Cell Transplantation Program is one of the largest and most experienced in the world.

CAR T-cell therapy is a type of cellular immunotherapy that involves genetically modifying a patient's T cells to attack their cancer. CAR T-cell therapy is FDA-approved for patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) that has relapsed or not responded to at least two prior lines of therapy, including a Bruton tyrosine kinase (BTK) inhibitor and a B-cell lymphoma 2 (BCL-2) inhibitor.

Jennifer R. Brown, MD, PhD: The Changing Definition of “High-Risk” CLL

Jennifer R. Brown, MD, PhD, director of the Center for Chronic Lymphocytic Leukemia, discusses how the definition of high-risk chronic lymphocytic leukemia has changed in the era of modern therapies and better understanding of the disease genomics.

Clinical Trials Questions?

877-338-7425

Clinical Trials

Patients have the opportunity to participate in clinical trials for new therapies for all phases of CLL, including advanced CLL. We have about 15 open CLL clinical trials at any one time. Most focus on novel agent combination approaches. We are also exploring CAR T-cell therapy for CLL in clinical trials. The goal of these trials is to extend the duration of patients' responses to treatment, and to improve outcomes.

Precursor Conditions to CLL

Monoclonal B-cell lymphocytosis (MBL) is the common precursor condition to CLL. Most people who develop CLL have had MBL, and about 1 percent per year will convert to CLL. Our researchers are studying the genomic, genetic, and epigenetic factors that characterize precancerous conditions at our Center for Prevention of Progression of Blood Cancers (CPOP).

We created the CPOP to understand, at the molecular level, why some patients go on to develop disease, while others do not — and to develop non-toxic targeted therapies to prevent progression, or even eliminate the disease before it leads to symptoms.

Contact CPOP

If you are a patient, or the physician of a patient, who is willing to have samples of blood and cancer cells collected for the CPOP research effort during a medical appointment, or if you would like additional information, please email precursor@partners.org or call 617-582-8664.

Breakthrough Research Informs Breakthrough Treatments

The last few years have been very encouraging for blood cancer research. Many new therapies are improving treatment outcomes for patients with CLL, and researchers at our Center for Chronic Lymphocytic Leukemia are driving much of the progress being made.

Many of our Center's cancer researchers conduct translational research, which quickly moves laboratory findings into clinical practice, including:

Dana-Farber researchers led the development and FDA approval of the targeted agents idelalisib and ibrutinib, and continue to test related next generation targeted agents which are better tolerated and potentially more effective.
Researchers at Dana-Farber led the research and offered the first-in-human trial of venetoclax, a Bcl-2 inhibitor. This led to the FDA approval of venetoclax for CLL patients with a specific subtype of CLL.
Current trials are combining agents to define new CLL regimens for future patients.
Examining genetic material of a variety of CLLs in order to identify genetic changes that cause CLL.
Studies to understand the mechanisms by which CLL becomes resistant to current therapy will help us identify new and more effective approaches to therapy.
Providing CLL samples to a large network of collaborators who are working to better understand how CLL develops and how we can best target it with the goal of finding a cure.

Studying the Influence of Genetics in CLL and Lymphoma

Our investigators are interested in learning more about the genes that contribute to CLL and lymphoma. This study will identify and study individuals with CLL/SLL or lymphoma who also have other family members with one of these diseases. We are particularly interested in families in which parents and children or brothers and sisters are both affected by CLL or lymphoma.

Participants will provide medical history along with blood samples, saliva samples, and mouth swabs. All information can be provided by mail. No travel to Boston is necessary. Investigators will use the information you provide to increase our understanding of the causes of lymphoma.

How to Participate

If you are interested and believe that your family history makes you eligible, please email Rayan Fardoun at rayan_fardoun@dfci.harvard.edu. Please include the following information:

Your diagnosis (type of lymphoma)
Your family members who have also had lymphoma (i.e. mother, brother, daughter, etc.)
Please indicate if you are willing to sign a medical release for research purposes and/or willing to donate a blood sample, saliva sample and mouth swab for research purposes.
Your contact information (name, email/phone number, mailing address)

Your Care

All outpatient therapy is provided at the Yawkey Center for Cancer Care at Dana-Farber Cancer Institute, one of the most advanced outpatient cancer centers in the country.

If you need to be hospitalized during your care, or if you undergo stem cell transplantation, you will be admitted to Brigham and Women's Hospital (BWH) or the Dana-Farber Inpatient Hospital located within BWH. Your primary oncologist and nurse will closely monitor your care and will coordinate your care with the inpatient team and additional specialists, who will address any other symptoms you may be experiencing. This model ensures seamless care from the outpatient to the inpatient setting. Learn more about your stay.

Second Opinions

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Second Opinions

Consultations and Second Opinions

We believe there is value in patients with suspected or diagnosed CLL receiving a second opinion.

Reasons to consider a second opinion include:

To confirm your diagnosis.
To be treated at Dana-Farber Brigham Cancer Center (if you have already received a diagnosis).
To determine the optimal therapy – and whether any is needed at this time.
To learn more about your cancer from specialists who are world leaders in studying this disease, and who have treated hundreds of other patients like you.
To learn if you're eligible for a clinical trial.

Phone: 877-442-3324

Online: Complete the Appointment Request Form

If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service.

In addition, we routinely evaluate specimens sent to us from outside centers. These specimens are examined by our expert hematopathologists.

Refer a Patient

How to Refer

For Referring Physicians

Because you, the referring physician, are an integral part of your patient's care team, we are committed to collaborating with you to provide the best care for your patient.

If you are a physician and have a patient with diagnosed or suspected CLL, we look forward to working with you. Learn how to refer a patient.