Chronic Lymphocytic Leukemia: Your Complete Treatment Guide
Updated on July 22, 2026
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Chronic lymphocytic leukemia (CLL) is a type of blood cancer that most often affects older adults. It happens when bone marrow, which is the spongy tissue inside your bones, makes too many lymphocytes, a type of white blood cell.
Chronic lymphocytic leukemia is a slow-growing cancer that develops over a long period. Initially, doctors may not recommend any treatment if the disease is caught early, since chronic lymphocytic leukemia is slow growing and often symptom free, and its treatments can cause harmful side effects. When treatments are needed, though, they may include targeted therapy, immunotherapy, chemotherapy, stem cell transplant, radiation therapy, or surgery.
There is no cure for chronic lymphocytic leukemia, but these treatments can help you effectively manage the disease and go into remission for a long time. The therapies you receive may depend on how advanced the cancer is, your overall health, symptoms, and other factors.
Additionally, your doctor will likely recommend testing the cancer for certain genetic changes. The results from these tests might reveal the best treatment options for you.
Be sure to talk to your healthcare provider before starting or combining any treatments for chronic lymphocytic leukemia.
Watchful Waiting
If chronic lymphocytic leukemia is caught early on, before it’s causing symptoms or other problems, your doctor may not recommend treatment right away. Research suggests treating early-stage chronic lymphocytic leukemia doesn’t improve survival rates. Instead, your doctor will carefully monitor the cancer and recommend treatment only when it progresses. This is often referred to as active surveillance or watchful waiting.
This approach avoids the potential side effects and complications of unnecessary treatment.
Targeted Therapy for Chronic Lymphocytic Leukemia
Targeted therapies work by focusing on specific proteins on or in cancer cells that help them grow. These therapies can be combined with chemotherapy, immunotherapy, or other treatments. Targeted therapy is usually the first option doctors try when treatment for chronic lymphocytic leukemia becomes necessary. The medication is usually taken by mouth.
The following are targeted treatments used for chronic lymphocytic leukemia.
Targeted Therapy Drug Class
Drugs Approved for CLL
BTK Inhibitors
acalabrutinib (Calquence)
ibrutinib (Imbruvica)
pirtobrutinib (Jaypirca)
zanubrutinib (Brukinsa)
BCL2 Inhibitors
venetoclax (Venclexta)
BTK Inhibitors
These medicines work by blocking the Bruton’s tyrosine kinase protein (BTK) protein, which helps chronic lymphocytic leukemia cells grow and multiply. BTK inhibitors that can be used for the initial treatment of chronic lymphocytic leukemia include:
- acalabrutinib (Calquence)
- ibrutinib (Imbruvica)
- zanubrutinib (Brukinsa)
Pirtobrutinib (Jaypirca) is another option that can be used to treat chronic lymphocytic leukemia, usually after there has been no response to other treatments.
Side effects of these medicines may include:
- Bleeding
- Chills and fever
- Cough
- Diarrhea
- Fatigue
- Headache
- Heart problems
- Infection
- Liver or kidney problems
- Nausea
- Pain
- Skin rash
- Tumor lysis syndrome (a life-threatening condition that can happen when cancer cells release their contents into the bloodstream)
BCL2 Inhibitor
Venetoclax (Venclexta) is a B cell lymphoma 2 (BCL2) inhibitor. It works by targeting BCL2, a protein that helps chronic lymphocytic leukemia cells live longer. Venetoclax is taken as a pill. Side effects include:
- Diarrhea
- Fatigue
- Infection
- Low blood cell counts
- Nausea
- Tumor lysis syndrome
Immunotherapy for Chronic Lymphocytic Leukemia
Immunotherapy boosts your body’s own immune system to attack cancer cells and kill them or slow their growth.
These are the immunotherapy treatments used for chronic lymphocytic leukemia.
IMMUNOTHERAPY DRUG CLASS
DRUGS APPROVED FOR CLL
Monoclonal Antibodies
obinutuzumab (Gazyva)
ofatumumab (Arzerra)
rituximab (Rituxan)
CAR T-Cell Therapy
lisocabtagene maraleucel (Breyanzi)
Monoclonal Antibodies
Monoclonal antibodies are synthetic or lab-made versions of antibodies that live in your immune system. Generally, monoclonal antibodies work by attaching to proteins on the surface of cancer cells to help the immune system identify and destroy the cancer. The antibodies are administered as an injection or by IV and can be given along with targeted therapy or chemo.
Monoclonal antibodies for chronic lymphocytic leukemia that focus on a protein called CD20 include obinutuzumab (Gazyva), ofatumumab (Arzerra), and rituximab (Rituxan).
These immunotherapy drugs can cause mild side effects, such as:
- Chills
- Constipation
- Fatigue
- Fever
- Headache
- Injection-site reactions
- Nausea
Sometimes, they can trigger more serious symptoms, such as:
- A racing heart
- Chest pain
- Coughing
- Dizziness
- Infection
- Swelling of the face and tongue
- Trouble breathing
Additionally, these medicines can lead to tumor lysis syndrome, stroke, severe infections, reactivation of a hepatitis B infection (if you’ve previously had one), or progressive multifocal leukoencephalopathy (a rare, serious viral infection that damages the brain).
CAR T-Cell Therapy
With chimeric antigen receptor (CAR) T-cell therapy, your immune cells, called T cells, are removed from your blood. The T cells are then altered in a lab by adding special receptors on their surface. Then the newly engineered T cells are reinfused into the body. Once in the blood, these new T cells multiply and seek out and destroy cancer cells.
Lisocabtagene maraleucel (Breyanzi) is currently the only CAR T-cell therapy available for chronic lymphocytic leukemia. It’s used to treat adults who have cancer that is still growing or has come back.
CAR T-cell therapy can cause serious side effects, such as:
- Cytokine release syndrome, which is a potentially life-threatening condition that happens when the immune system overreacts and causes symptoms such as breathing problems, chills, diarrhea, fever, headache, nausea, and weakness
- Low blood cell counts
- Serious neurological issues, such as changes in consciousness, confusion, seizures, tremors, and trouble speaking
- Severe infections
- A weakened immune system
Chemotherapy for Chronic Lymphocytic Leukemia
Chemotherapy uses drugs to kill cancer cells throughout the body. While chemotherapy was once a first-line treatment for chronic lymphocytic leukemia, it’s used much less often today. Many people with chronic lymphocytic leukemia are now treated first with targeted therapies or immunotherapy, which are often more effective and may cause fewer side effects. But chemotherapy may still be an option in certain situations, such as when you:
- Need a quick response to treatment
- Can’t take other available treatments
- No longer respond to other treatments
- Are getting a stem cell transplant
Chemo drugs can also be combined with immunotherapy, known as chemoimmunotherapy, to treat chronic lymphocytic leukemia.
Chemotherapy may be given via IV or a pill. It’s usually administered in cycles, with rest periods to allow the body to recover between rounds of treatment.
When chemotherapy is used to treat chronic lymphocytic leukemia, it may include the following medicines:
- bendamustine (Treanda)
- chlorambucil (Leukeran)
- cyclophosphamide (Cytoxan)
- fludarabine (Fludara)
Side effects of these chemotherapy drugs include:
- Easy bleeding or bruising
- Fatigue
- Frequent infections
- Hair loss
- Loss of appetite
- Low blood cell counts
- Mouth sores
- Nausea
- Vomiting
- Tumor lysis syndrome
Stem Cell Transplant for Chronic Lymphocytic Leukemia
A stem cell transplant, also called a bone marrow transplant, is an option for people with chronic lymphocytic leukemia types that are harder to treat, such as cancers with chromosome 17 deletions or TP53 gene mutations. It’s not clear yet how helpful stem cell transplants are for people with chronic lymphocytic leukemia. A stem cell transplant for chronic lymphocytic leukemia is usually done as part of a clinical trial.
With a stem cell transplant, chemotherapy is first used to wipe out the stem cells in the bone marrow that are causing chronic lymphocytic leukemia. Then healthy stem cells — usually from a donor — are infused into your blood to restore the cells in your bone marrow.
This treatment can cause severe, even life-threatening side effects, such as:
- Bleeding or other issues associated with low blood cell counts
- Graft failure, when your body rejects the new stem cells
- Graft-versus-host disease, when immune cells from the donor attack your body
- Lung problems
- Serious infections
- Sinusoidal obstructive syndrome, when tiny blood vessels in the body become blocked, which can become serious
Radiation Therapy for Chronic Lymphocytic Leukemia
With radiation, high-energy particles or rays destroy cancer cells in the body. Radiation therapy is sometimes used in people with chronic lymphocytic leukemia to lessen pain due to an enlarged spleen or swollen lymph nodes.
Common side effects of radiation may include fatigue and skin irritation.
Surgery for Chronic Lymphocytic Leukemia
Surgery isn’t common for chronic lymphocytic leukemia. But in rare cases, doctors may perform a splenectomy, which is a procedure to remove the spleen.
One of the spleen’s jobs is to remove worn-out blood cells from the bloodstream. With chronic lymphocytic leukemia, the spleen can grow large, become overactive, and remove too many blood cells from the body. An enlarged spleen can also put pressure on nearby organs, which may lead to pain.
A splenectomy can help improve blood counts and lessen the symptoms of an enlarged spleen.
Clinical Trials for Chronic Lymphocytic Leukemia
Clinical trials are research studies that test the safety and effectiveness of treatments. Many current chronic lymphocytic leukemia treatment options, such as targeted therapy and immunotherapy, were first studied in clinical trials before becoming the standard of care. Participating in a clinical trial may be a way to receive a novel treatment that isn’t available yet to the public.
There are several treatments and drug combinations for chronic lymphocytic leukemia on the horizon that are currently being investigated in clinical trials. If you think you might be interested in joining a clinical trial, ask your doctor for help finding one that may be right for you.
Lifestyle Changes
There’s no known way to prevent chronic lymphocytic leukemia, but some lifestyle habits can help you reduce symptoms and better manage the disease.
- Follow a healthy diet. A Mediterranean-style diet that focuses on fish, fruits and vegetables, legumes, and whole grains can reduce cancer fatigue and improve your overall health.
- Stay active. Exercising regularly can help you boost your immunity, build strength, and manage fatigue.
- Reduce stress. Having a cancer diagnosis can be stressful. You may want to try deep breathing, meditation, or other relaxation exercises to help lower stress.
- Protect yourself from infection. Stay up to date on vaccinations, and wash your hands regularly to prevent infections.
- Get regular screenings. If you have chronic lymphocytic leukemia, you may also have an increased risk of other cancers, such as colon cancer, lung cancer, and skin cancer. Don’t skip screenings that could help detect these cancers early.
Complementary and Integrative Approaches
Some complementary and integrative approaches may help you feel better and lessen symptoms or treatment side effects, such as fatigue. Popular options include acupuncture, massage, and yoga.
Be sure to talk to your doctor before adding any type of complementary therapy to your treatment regimen.
Pain Management
There are many therapies to help ease pain from chronic lymphocytic leukemia. These include:
- Over-the-counter pain relievers, such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen [Advil], or naproxen [Aleve]), for moderate pain
- Opioids, such as hydrocodone, morphine, or oxycodone, for moderate-to-severe pain
- Antidepressants and antiepileptics for nerve/neuropathy-related pain
- Steroids, such as dexamethasone or prednisone, to help ease pain caused by inflammation or swelling
Before starting any pain medication, it’s important to speak with your doctor about which to take, how much to take, how to take it, and how often to take it. This includes over-the-counter medications, because some people should not take these drugs, even if they’ve taken them before.
Mental Health Treatment
A chronic lymphocytic leukemia diagnosis can take a toll on your mental health. Staying connected with family and friends can help you cope with emotional challenges. Some people also benefit from joining an online or in-person support group where they can connect with others who have chronic lymphocytic leukemia.
If you start to experience severe sadness or hopelessness, you may want to speak to a mental health professional who can offer you resources or medication options.
Resources We Trust
- Mayo Clinic: Chronic Lymphocytic Leukemia
- Cleveland Clinic: Exploring Novel Strategies for Chronic Lymphocytic Leukemia
- Blood Cancer United: Chronic Lymphocytic Leukemia (CLL) Treatment
- American Cancer Society: Supportive or Palliative Care for Chronic Lymphocytic Leukemia (CLL)
- MD Anderson Cancer Center: 7 Pain Management Options for Cancer Patients You Might Not Know About
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- Chronic Lymphocytic Leukemia (CLL). Cleveland Clinic. April 8, 2026.
- Chronic Lymphocytic Leukemia Treatment (PDQ®)–Patient Version. National Cancer Institute. October 15, 2024.
- What Is Chronic Lymphocytic Leukemia (CLL)? Moffitt Cancer Center.
- Typical Treatment of Chronic Lymphocytic Leukemia (CLL). American Cancer Society. February 20, 2026.
- Targeted Therapy Drugs for Chronic Lymphocytic Leukemia (CLL). American Cancer Society. February 20, 2026.
- Immunotherapy for Chronic Lymphocytic Leukemia (CLL). American Cancer Society. March 20, 2025.
- Chemotherapy for Chronic Lymphocytic Leukemia (CLL). American Cancer Society. March 20, 2025.
- Stem Cell Transplant for Chronic Lymphocytic Leukemia (CLL). American Cancer Society. March 20, 2025.
- Stem Cell or Bone Marrow Transplant Side Effects. American Cancer Society. July 17, 2026.
- Radiation Therapy Side Effects. National Cancer Institute. May 15, 2025.
- Surgery for Chronic Lymphocytic Leukemia (CLL). American Cancer Society. March 20, 2025.
- Chronic Lymphocytic Leukemia. Mayo Clinic. October 24, 2025.
- Treatment Clinical Trials for Chronic Lymphocytic Leukemia (CLL). National Cancer Institute.
- Bowman A. CLL and Lifestyle: 8 Changes That Can Help Ease Symptoms and Slow Cancer Progression. Mayo Clinic. February 26, 2025.
- Living as a Chronic Lymphocytic Leukemia Survivor. American Cancer Society. March 20, 2025.
- Pain. Blood Cancer United.
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Daniel Landau, MD
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Daniel Landau, MD, is a distinguished board-certified hematologist-oncologist with a career that has spanned two eminent institutions: the Orlando Health Cancer Institute and the M...
Julie Lynn Marks
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Julie Marks is a freelance writer with more than 20 years of experience covering health, lifestyle, and science topics. In addition to writing for Everyday Health, her work has bee...