Relapsed/Refractory or Later Therapies

As the name suggests, these therapies are used second line and later. There are many options and understanding how they fit into the CLL/SLL journey will help you best plan your management strategy with your healthcare team.

Action Items for Relapsed/Refractory or Later Therapies

Understand that there are two broad categories:

The first is the approved or available treatments. These would include standard of care single agents or combinations of approved medications. It also could include “off label” use of drugs not approved for R/R CLL/SLL but approved for other indications and believed to be active in CLL/SLL.

The second excellent choice would be an experimental therapy in an appropriate clinical trial.

The first is the approved or available treatments. 

These would include standard of care single agents or combinations of approved medications. It also could include “off label” use of drugs not approved for R/R CLL/SLL but approved for other indications and believed to be active in CLL/SLL.

The second excellent choice would be an experimental therapy in an appropriate clinical trial.


Option 1

Please start by reviewing this general introduction to the classes of medications used to treat CLL/SLL: Brief Overview of Types of Treatments.

Next should be this list of CLL Approved Medications. All the drugs listed can be used in R/R CLL, but today there is no longer any role for any of the chemo drugs listed (bendamustine, fludarabine and cyclophosphamide) for R/R patients. Off label use of zanubrutinib and lenalidomide might also be considered.

Take a deeper dive to read about the drug or drugs you are considering by searching the website for any particular medicine. Finally, search our website for all the trial data to best inform your choice. The data can be overwhelming so take your time researching and ask your healthcare teams lots of questions.


Option 2

Clinical trials are often the best choice as they are where all the new breakthroughs start. Care in clinical trials is excellent. Clinical Trial Phases, the Drug Approval Process, and Measuring Responses is a good starting point. Then dig in and search the website by the trial name if you know it or by the medications used. For the personal patient perspective on trial participation, we offer several articles. One is this video: One Patient’s Powerful Story or this article: Could a CLL Clinical Trial Save My Life? What Were the Risks? or this patient classic from 2015: Deciding to Enroll in a Phase I Clinical Trial for Our CLL (chronic lymphocytic leukemia). Searching our website under clinical trials will pull up a lot more. Finally, before you leave CLLSociety.org and visit clinicaltrials.gov, stop first at How to Understand and Get the Most Out of ClinicalTrials.gov.  As with all things CLL/SLL related, take your time and take notes. Ask questions. There is a flood of information out there.

ADDITIONAL READING

The short answer is that it is certainly beginning to look that way for a lucky few. This month celebrated the 10th CAR-T anniversary of Doug Olson, who remains cancer-free with persistent CAR-T cells that still play WHACK-A-MOLE should any cancerous CLL cells dare to reappear.