Kevin Kim

Kevin Kim

Question: Are there any new treatment options for Chronic Lymphocytic Leukemia?

Chronic lymphocytic leukemia (CLL) is a common cancer of the bone marrow. It accounts for about 30% of all leukemias in the United States. It affects men more often than women, and it mostly affects older adults with the median age at diagnosis of 70. Many patients are diagnosed when they are found to have elevated white blood cells (WBC) on their blood test.

It is common for patients to not have any symptoms at diagnosis. When patients do have symptoms, it can be fever, drenching night sweats, weight loss or extreme fatigue. These symptoms are called “B” symptoms. They may also have enlarged lymph nodes in their neck, armpit or groin.

A blood test may reveal anemia (low red blood cells) or thrombocytopenia (low platelets). Diagnosis is confirmed with a special blood test called flow cytometry. An oncologist may also elect to obtain a lymph node biopsy or a bone marrow biopsy. If the disease is predominantly involving the lymph nodes, it is called small lymphocytic lymphoma (SLL). However CLL and SLL are essentially the same disease and are managed in the same way.

Not every patient with CLL needs treatment. If the patient has no symptoms or abnormal blood count other than elevated WBC or markedly enlarged lymph nodes, then the oncologist may simply elect to monitor the patient. Many of these patients can live a normal life without ever requiring treatment.

Some patients with CLL do need treatment. Indications for treatment include presence of “B” symptoms, markedly enlarged lymph nodes or significantly abnormal blood counts. Treatments have historically been intravenous chemotherapy, such as fludarabine, cyclophosphamide and doxorubicin. However, recent advances in oncology have greatly expanded treatment options for CLL, including non-chemotherapy, oral medications.

An oncologist can obtain specialized molecular testing, which can help determine prognosis and predict which treatment will provide the best outcome. A vast majority of patients who require treatment respond well to these treatments and go into remission, either complete or partial. However, remission is never permanent and patients often need a different treatment when their disease relapses.

Fortunately, oncologists now have a full armamentarium of drugs to treat CLL. There is also continued progress in the development of immunotherapy, such as chimeric antigen receptor T cell (CAR-T therapy. CLL/SLL is a common bone marrow cancer that affects older adults. It is an indolent disease that often does not require treatment.

For patients who need treatment, there are many effective treatments available. To find out more about Chronic Lymphocytic Leukemia contact our Nurse Navigators at Mission Hope with your questions at 805-219-HOPE (4673).

HAVE A QUESTION? This weekly column produced by Marian Cancer Care invites you to submit your questions to “Your Cancer Answers” at the following email address: mariancancercare@dignityhealth.org

Dr. Kevin Kim is Board Certified and Fellowship trained in Medical Oncology and Hematology at Mission Hope Cancer Center. He treats people with cancer and hematology disorders and serves as a member of the Marian Regional Medical Center’s and Arroyo Grande Community Hospital’s specialized oncology staff. He can be reached at 805-349-9393.

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