Navigating Treatment | Treatment Options

If you have been diagnosed with CLL, it's important to discuss the treatment options available, along with the risks, side effects and benefits of each option with your healthcare team. Treatment options are contingent upon a variety of factors, including the stage of CLL, potential side effects, your age, and overall health. Your preferences are also an important consideration. Your treatment plan may also include treatment for any side effects or symptoms you experience. CLL often progresses slowly and many people may not need treatment right away.

Active Surveillance or Watchful Waiting: Your healthcare team may recommend observation without treatment where your CLL will be monitored carefully if you have early–stage CLL and no symptoms. If symptoms appear and the CLL progresses, then additional treatment options should be discussed with your healthcare team. People with CLL that are not on active treatment, should work with their healthcare team to improve their overall health, including bringing immunizations up to date (with the exception of the shingles vaccine).

	Without 17p Deletion and TP53 Mutation	With 17p Deletion and TP53 Mutation
Preferred Regimens	Acalabrutinib with or without obinutuzumab Venetoclax and obinutuzumab Zanubrutinib	Acalabrutinib with or without obinutuzumab Venetoclax with or without obinutuzumab Zanubrutinib
Other Recommended Regimens	Ibrutinib Bendamustine and either rituximab or obinutuzumab Chlorambucil and obinutuzumab Obinutuzumab	Alemtuzumab with or without rituximab High-dose methylprednisolone (HDMP) and rituximab Ibrutinib Obinutuzumab
Sometimes Useful Regimens	Fludarabine, cyclophosphamide, and rituximab (FCR) may be used to treat CLL with IGHV mutations in people who are under 65 years of age and fairly healthy	-

Without 17p Deletion and
TP53 Mutation

With 17p Deletion and
TP53 Mutation

Preferred Regimens

Acalabrutinib with or without obinutuzumab
Venetoclax and obinutuzumab
Zanubrutinib

Acalabrutinib with or without obinutuzumab
Venetoclax with or without obinutuzumab
Zanubrutinib

Other Recommended Regimens

Ibrutinib
Bendamustine and either rituximab or obinutuzumab
Chlorambucil and obinutuzumab
Obinutuzumab

Alemtuzumab with or without rituximab
High-dose methylprednisolone (HDMP) and rituximab
Ibrutinib
Obinutuzumab

Sometimes Useful Regimens

Fludarabine, cyclophosphamide, and rituximab (FCR) may be used to treat CLL with IGHV mutations in people who are under 65 years of age and fairly healthy

	Without 17p Deletion and TP53 Mutation	With 17p Deletion and TP53 Mutation
Preferred Regimens		Acalabrutinib Venetoclax with rituximab Venetoclax Zanubrutinib
Other Regimens		Ibrutinib Alemtuzumab with or without rituximab Duvelisib High-dose methylprednisolone (HDMP) and rituximab Idelalisib with or without rituximab Lenalidomide with or without rituximab
When Prior Treatment Consisted of a BTK Inhibitor, Options May Include:	Venetoclax and rituximab (preferred) or venetoclax if not received before For some people, one of these BTK inhibitors—may be an option: acalabrutinib (preferred), zanubrutinib (preferred), or ibrutinib
When Prior Treatment Consisted of Venetoclax, Options May Include:	Repeating first-line venetoclax with obinutuzumab for second-line therapy if the cancer had been in remission Acalabrutinib (preferred), zanubrutinib (preferred), or ibrutinib
When Prior Treatment Consisted of Chemoimmunotherapy or immunotherapy	Venetoclax and rituximab (preferred) or venetoclax Acalabrutinib (preferred), zanubrutinib (preferred), or ibrutinib

Without 17p Deletion and TP53
Mutation

With 17p Deletion and TP53
Mutation

Preferred Regimens

Acalabrutinib
Venetoclax with rituximab
Venetoclax
Zanubrutinib

Other Regimens

Ibrutinib
Alemtuzumab with or without rituximab
Duvelisib
High-dose methylprednisolone (HDMP) and rituximab
Idelalisib with or without rituximab
Lenalidomide with or without rituximab

When Prior Treatment Consisted of a BTK Inhibitor, Options May Include:

Venetoclax and rituximab (preferred) or venetoclax if not received before
For some people, one of these BTK inhibitors—may be an option: acalabrutinib (preferred), zanubrutinib (preferred), or ibrutinib

When Prior Treatment Consisted of Venetoclax, Options May Include:

Repeating first-line venetoclax with obinutuzumab for second-line therapy if the cancer had been in remission
Acalabrutinib (preferred), zanubrutinib (preferred), or ibrutinib

When Prior Treatment Consisted of Chemoimmunotherapy or immunotherapy

Venetoclax and rituximab (preferred) or venetoclax
Acalabrutinib (preferred), zanubrutinib (preferred), or ibrutinib

Treatment Options

What are my treatment options?