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Genetics of chronic lymphocytic leukemia (CLL)

Scientists are learning a lot about the gene and chromosome changes inside CLL cells that make them different from normal cells, and how these changes affect their growth and their responses to different treatments.

This type of information is being used to help know when treatment needs to be started, which treatments are most likely to work, and what a person's long-term outlook is likely to be.

It's also changing the way CLL is treated. Newer targeted drugs that focus on some of these gene changes have changed the way CLL is treated in recent years (see below).

As doctors learn more about the many gene changes that can take place in CLL cells, they're using this knowledge to break CLL into groups of sub-types. This could lead to better understanding of the many treatment outcomes seen in people with CLL today.

New medicines for chronic lymphocytic leukemia (CLL)

At one time, chemotherapy (chemo) was the main treatment for CLL. But newer types of medicines, which tend to work better and often have fewer side effects, have largely replaced it.

Targeted drugs?

Newer, targeted drugs are an important part of treatment for most people with CLL. These medicines affect parts of the leukemia cells that make them different from normal cells. Doctors are now trying to figure out the best combinations and sequences for giving these drugs, and if some might work better in people whose CLL cells have certain gene or chromosome changes.

Many? new targeted drugs are also being tested for use in CLL clinical trials.

Immunotherapy?

These types of medicines help a person's immune system find and attack the leukemia cells. Some types of immunotherapy are now being used to treat CLL, while many others are being studied.

CAR T-cell therapy

For CAR (chimeric antigen receptor) T-cell therapy, a person's T cells, a type of white blood cell, are removed from their blood and then altered and grown (multiplied) in a lab. They're then put back in the person's bloodstream so they can find and destroy CLL cells in the body. These treatments may be an option for some people with CLL, typically after other treatments have been tried.

To learn more about CAR T-cell therapy for CLL, see Immunotherapy for Chronic Lymphocytic Leukemia.

Bispecific monoclonal antibodies

These are drugs are made up of parts of 2 different monoclonal antibodies (immune system proteins), so they can attach to proteins on 2 different types of cells at the same time. In bispecific T-cell engagers (BiTEs) one part attaches to a protein on the leukemia cells, and the other part sticks to a protein on immune cells called T cells. This brings the immune cells together with the leukemia cells, which helps the immune system mount a more effective response against them.

BiTEs are becoming an important part of treatment for some types of cancer, and are now being studied for use against CLL.

Vaccine therapy

The use of vaccines as cancer treatment is a research interest in many different kinds of cancer. Instead of preventing cancer, these vaccines try to get the immune system to mount an attack against cancer cells in the body.

Some early studies are testing vaccines made from a person's CLL cells and a protein that boosts the immune system's ability to kill the CLL cells. These studies are still in early phases, and it will take time before we know whether vaccine therapy works.