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How We Treat Chronic Lymphocytic Leukemia


  • 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.

  • Our Unique Approach

    The Center for Chronic Lymphocytic Leukemia is part of Dana-Farber/Brigham and Women'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, nursing professionals, physician assistants, psychologists, and social workers — 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. Laboratory investigators, clinical care coordinators, clinical social workers, and nutritionists are also part of your care team.

    Personalized Treatment

    As a highly specialized Center within DF/BWCC'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.

    Specialized Programs for Patients of All Ages

    Our Older Adult Hematologic Malignancy Program is a specialized DF/BWCC research and clinical service that addresses the specialized needs of blood cancer patients age 75 and older. Our geriatricians work closely with oncologists to create individualized treatment plans for older patients that take into account other illnesses or concerns. These patients may participate in research protocols tailored to older adults, including clinical trials and tissue banking efforts.

    Our research efforts also include trials specifically for younger patients who are diagnosed with CLL. Though this diagnosis is less common, our program is exploring new and more effective therapies for this younger population.

    Offering Expertise Through Second Opinions

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

    We routinely evaluate specimens sent to us from outside centers. These specimens are examined by our expert hematopathologists.

    Reasons to consider a second opinion include:

    • To confirm your diagnosis.
    • To be treated at Dana-Farber/Brigham and Women's 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-DFCI or 877-442-3324

    Online: Complete the Appointment Request Form.

    If you cannot travel to Boston in person, you can take advantage of our /appointments-and-second-opinions/online-second-opinion-program/ Online Second Opinion service.

    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 CML, we look forward to working with you. Learn how to refer a patient.

    Treatment 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 some patients with early stage CLL, immediate treatment is not necessary, though treatment will likely be needed when the disease progresses.

    Treatments can include:

    Watchful Waiting
    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 chemotherapy and/or targeted drug therapy. When treatment is needed, you will have a CT scan and a bone marrow biopsy.

    Chemotherapy
    We sometimes combine two or more chemotherapy drugs, which can strengthen their effectiveness, or deliver them to patients one after another.

    Your treatment team carefully considers which combination will work best for you at each stage, and how to sequence them.

    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, ofatumumab, and obinutuzumab.

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

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

    Clinical Trials

    Patients have the opportunity to participate in trials for new therapies for all phases of CLL, including advanced CLL. We have about 15 open CLL clinical trials at any one time. The goal of these trials is to extend the duration of patients' responses to treatment, and to improve outcomes.

    These trials include:

    • Agents that prime CLL cells to die when they are hit with chemotherapy.
    • Drugs that block key drivers of CLL cell growth, including kinase inhibitors.
    • Combinations of novel agent therapies with potential for synergy.

    Disease-Modifying Therapies

    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.

    Related Links

    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.
    • 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 Lymphoma

    Our investigators are interested in learning more about the genes that contribute to lymphoma. This study will identify and study individuals with non-Hodgkin's lymphoma, Hodgkin's disease or CLL/SLL 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 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 Harrison Bai at HarrisonP_Bai@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.