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Chronic Lymphocytic Leukemia (CLL)
When treatment is needed for chronic lymphocytic leukemia (CLL), targeted drugs are often part of the first line of treatment.
Targeted therapies are drugs that specifically focus on some of the changes inside cancer cells that help them grow. Unlike standard chemotherapy drugs, which work by attacking rapidly growing cells in general (including cancer cells), these drugs target one or more specific proteins on or in CLL cells.
BTK is a protein that normally helps some CLL cells grow and survive. Drugs that target this protein are known as BTK inhibitors. These drugs can be helpful in treating CLL.
BTK inhibitors used to treat CLL include:
Ibrutinib can be used in the initial treatment of CLL. It has also been shown to help when CLL is hard to treat. For example, ibrutinib can be helpful if the CLL cells have a chromosome 17 deletion (del17p) or if the CLL has come back after other treatments.
This drug is a pill, typically taken daily.
Acalabrutinib can be used in the initial treatment of CLL or after other treatments have been tried. It might be used alone or along with other drugs.
This drug is a capsule taken by mouth, typically twice a day.
Zanubrutinib can be used in the initial treatment of CLL or after other treatments have been tried.
This drug is a pill taken by mouth, typically once or twice a day.
Pirtobrutinib is a newer type of BTK inhibitor that works in a slightly different way. It can be used to treat CLL, typically after other treatments (including another BTK inhibitor and a BCL-2 inhibitor) have been tried.
This drug is taken by mouth as pills, typically once a day.
BCL-2 is a protein in CLL cells that helps them live longer than they should. Drugs that target this protein are known as BCL-2 inhibitors. These drugs can be helpful in treating CLL.
Venetoclax can be used alone or along with a monoclonal antibody, such as rituximab or obinutuzumab. It's taken as a pill, typically once a day.
Tumor lysis syndrome (TLS) is another possible side effect of this drug. It's more common in people who have large numbers of leukemia cells in their body when treatment starts. (This may be called bulky disease.)
When the CLL cells are killed, they break open and release their contents into the bloodstream. The kidneys can be overwhelmed to the point that they can't get rid of these substances fast enough. This can lead to build up of excess amounts of certain minerals in the blood and even kidney failure. The excess minerals can cause problems with the heart and nervous system.
To help keep this from happening, your doctor may start you on venetoclax at a very low dose and then slowly increase it over about 5 weeks. Your treatment team will do blood tests and also watch for signs of TLS.
Phosphatidylinositol 3-kinases (PI3Ks) are a family of proteins that send signals in cells that can affect cell growth. Drugs that target these proteins, known as PI3K inhibitors, can be helpful in treating CLL.
PI3K inhibitors used to treat CLL include:
Idelalisib blocks a kinase protein called PI3K-delta. This drug has been shown to help treat CLL after other treatments have been tried. It's a pill, typically taken twice a day.
Duvelisib blocks two kinase proteins called PI3K-delta and PI3K-gamma. This drug has been shown to help treat CLL after other treatments have been tried. It's a pill, typically taken twice a day.
To learn more about how targeted drugs are used to treat cancer, see Targeted Cancer Therapy.
To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
National Cancer Institute. Chronic Lymphocytic Leukemia Treatment (PDQ®)–Health Professional Version. 2025. Accessed at https://www.cancer.gov/types/leukemia/hp/cll-treatment-pdq on February 19, 2025.
National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 2.2025. Accessed at https://www.nccn.org on February 19, 2025.
Rai KR, Stilgenbauer S. Selection of initial therapy for symptomatic or advanced chronic lymphocytic leukemia/small lymphocytic lymphoma. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/selection-of-initial-therapy-for-symptomatic-or-advanced-chronic-lymphocytic-leukemia-small-lymphocytic-lymphoma on February 19, 2025.
Rai KR, Stilgenbauer S. Treatment of relapsed or refractory chronic lymphocytic leukemia. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/treatment-of-relapsed-or-refractory-chronic-lymphocytic-leukemia on February 19, 2025.
Last Revised: March 20, 2025
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