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October 2021 CLL Bloodline

In science and medicine, information is constantly changing and may become out-of-date as new data emerge. All articles and interviews are informational only, should never be considered medical advice, and should never be acted on without review with your health care team.

Over the course of a year of monthly meetings, The CLL Bloodline will teach the BASICS needed to understand CLL, bring news, help with the acronym and new vocabulary, and offer simple fun quizzes.

MONTHLY QUIZ:  The spleen is important in CLL. All the following are true EXCEPT:

  1. The white pulp of the spleen acts as an immune organ, much like a giant lymph node. Both normal and cancerous lymphocytes can grow here, sometimes leading to massive enlargement.
  2. The red pulp acts to rid the body of old red blood cells and platelets and recycles their contents, including the iron. When enlarged, it can overdo the clearing out leading to anemia and low platelets.
  1. The spleen can serve as a back up to the bone marrow by releasing blood cells into the circulation.
  2. One can live without a well-functioning spleen or even after its total removal.
  3. 30% of people have a tiny 2nd spleen called a splenule or accessory spleen that grows if the spleen is removed.
  4. Removal of the spleen is sometimes done prophylactically in CLL to lower the risk of infections.

The correct answer is #6 The spleen helps the body remove certain common “encapsulated” bacteria that can cause pneumonia, meningitis and other infections and its removal is associated with more serious infections.

NEWS: The FDA expanded the emergency use authorization for Lilly’s bamlanivimab and etesevimab (administered together) to include emergency use as post-exposure prophylaxis (prevention) for COVID-19. This is like the expanded approval last month for Regen-Cov. There is a significant caveat. Bamlanivimab and etesevimab are authorized for use only in locales where the combined frequency of variants resistant to bamlanivimab and etesevimab administered together is ≤ 5%.

Join us on October 15th for the  CLL Society Ed Forum: The Right Tests at the Right Time to learn the basics about testing across the span of your CLL journey.

THE BASICS: In an earlier Bloodline, we discussed factors that go into deciding your choice of therapy. This month we explain targeted therapies that are generally our best choice. This gets detailed, but the crucial point is that “targeting” drugs work.

Targeted Therapies (TT) are drugs that interfere with specific “targets” important to cancer cell growth and survival. In CLL these include monoclonal antibodies (mAbs) that attack a specific protein found on the cells’ surface. This protein may be found on some normal cells but not on most cells. Examples include rituximab, ofatumumab (now rarely used), obinutuzumab and ublituximab (experimental) that target CD20 found only on CLL and normal B cells. Another TT are TKIs or tyrosine kinase inhibitors that inhibit enzymes such as BTK which is blocked by ibrutinib, acalabrutinib and pirtobrutinib aka LOXO-305 (experimental) or PI3K blocked by idelalisib, duvelisib and umbralisib (experimental). Both BTK and PI3K are part of the B cell receptor (BCR) pathway that the cancer has become “addicted” to and is critical to its survival. Blocking it turns off the messages the cancer gets to live long and proliferate. Venetoclax and the experimental lisaftoclax are different and are not TKIs. They turn back on apoptosis or programmed cell death, leading to rapid killing of the CLL cells. Those CLL cells had turned off that death pathway to improve survival. Unlike chemotherapies, TT do not damage DNA or target all fast-growing tissues, cancerous or not, such as hair or the gut. The important point is that because TT are “targeted,” they tend to cause less collateral damage. They are often newer, more effective and expensive than “chemo” that was discussed in the last Bloodline.


Immunotherapy therapy uses our immune system to fight cancer and are made from living organisms. They include mAbs (monoclonal antibodies) and CAR-Ts (genetically modified T cells). It may also be called biological therapy or targeted therapy.