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CLL disease: live a good quality of life alongside the disease

Chronic lymphocytic leukemia, or CLL as it is better known, is the most common leukemia disease in the Western world. Here is everything you need to know about the possible treatments for the disease, which can ensure a good quality of life over many years

• Leukemia

Prof. Tamar Tadmor in collaboration with the Association for Patient Rights

By: Prof. Tamar Tadmor The director of the Hematology Institute at Bnei Zion Hospital

in Israel has about thousands of CLL patients, and about 500 more people are diagnosed each year. It is the most common leukemia in Israel and in the Western world, and is especially common among Ashkenazi Jews of old age. The disease is manifested by increased production of type B lymphocytes, which are a type of white blood cell that is produced in the bone marrow and migrates to the lymph nodes, where they serve as part of the immune system and protect against infections. In CLL patients, the cancer cells multiply rapidly and the white blood cell count reaches extremely high values.

This cell culture can lead to enlargement of the lymphatic system, which includes the lymph nodes and spleen. Sometimes the disease cells cause a decrease in the production of healthy cells in the bone marrow, when there is a decrease in the production of red blood cells the disease will manifest itself in anemia. Decreased white blood cell production can increase the tendency for infections, and rarely there is also a decrease in platelet production. But many patients are asymptomatic, meaning they do not experience any of these symptoms.

In most cases the diagnosis of the disease is done randomly, the patient performs a routine blood count and the family doctor notices a high white blood cell count. Sometimes patients notice enlarged lymph nodes and very rarely a patient feels pain originating from internal lymph nodes, for example abdominal pain caused by lymph nodes in the abdomen or difficulty breathing caused by the glands in the chest. The diagnosis of the disease is quite simple and does not require invasive tests but a three-month follow-up of the white blood count, and a cell characterization test in which the characteristics unique to the CLL cells are examined, and it provides an unambiguous result for the diagnosis of the disease.

Without chemotherapy and with better results

The purpose of CLL treatment is not to cure the disease, as it is a chronic disease, but to allow a good quality of life alongside the disease. Many asymptomatic patients can live with CLL for many years in good health as their bone marrow continues to produce healthy cells as well, and therefore these patients do not need any medication. It is estimated that about half to two-thirds of patients will need medication.

The introduction of biologics in recent years has led to a dramatic change in the treatment of CLL, with the most significant change occurring this year when it was decided to allow first-line treatment with only biologic therapies without combining chemotherapy, thus significantly reducing the known side effects of chemotherapy.

The biological treatment for CLL is divided into three treatment groups. The first and oldest group is treatment with an anti-cd20 monoclonal antibody. It includes in the first generation the drug Mabatra (Rituximab) and in the second generation the drug Gazeba (Obinotuzumab) which has shown higher efficacy, both of these drugs are given intravenously.

Another treatment group is B-cell receptor inhibitors, or BTK inhibitors. The drugs in this group are already given orally, that is, in pills, and it includes the drug Imbrovica (ibrotinib). The drug acts quickly and dissolves the glands, but it is given as a long-term treatment, meaning patients have to take it regularly for a long time to keep the disease under control, if they stop treatment the disease can arise. More advanced treatments are currently being added to the BTK inhibitor group.

The third group of treatments includes oral drugs that inhibit intracellular protein called BCL2 whose function is to disrupt the cellular death mechanism that exists naturally in every cell. The new drugs neutralize the effect of the protein and thus allow the death of the disease cells. These are very effective drugs and are usually given in combination with drugs from the anti-CD20 group. In this family there is a drug Vancelaste (Ventocles) and it is common to combine it with a drug Gazeba. These treatments have the advantage over BTK inhibitors in that their treatment is timed - the Bunlexa treatment is given for one year and at the same time the anti-CD20 antibody treatment is given once a month for six months. The combined treatment leads to a deep response and in high percentages with no residual disease at the end of the treatment. However because it is a very effective treatment, it can lead to rapid destruction of the cells and therefore Valkelste is given gradually in a dose that increases every month until full dose is reached within half a year.

In addition to the existing treatments, studies are constantly being conducted that examine the development of new drugs with a higher safety profile and high therapeutic efficacy, as well as attempts to find better treatment stages between the existing treatment groups.

There is no doubt that the good news about leukemia is not simple, but it is important to remember that in the case of CLL a diagnosis does not necessarily require medication. And when treatment is needed, the variety of new treatments, the possibility of taking the drugs in pills and not intravenously and of course the release from the need for chemotherapy allows CLL patients to live a better quality of life.