If SLL is not causing symptoms, you may not need treatment immediately. Early treatment at this stage doesn’t increase a person’s life span and can cause side effects.
You will be seen regularly by your cancer specialist or GP, and treatment will be advised if you develop symptoms. It may be some time before this happens, and some people may never need any treatment.
After treatment, many people have a period of time with no signs of active disease known as remission. If the lymphoma comes back, it can be treated again. This can give another period of remission and the lymphoma can often be controlled in this way for many years.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is an important treatment for small lymphocytic lymphoma and can often get it into remission.
Chemotherapy can be given as tablets or into a vein (intravenously). You may be given a single drug or you may be given two or more drugs together (combination chemotherapy). You can usually have chemotherapy as an outpatient.
Chemotherapy is often given in combination with a drug called rituximab (Mabthera ®), a monoclonal antibody that targets B-cells.
The drugs most often used to treat SLL are:
Chlorambucil is usually taken on its own. It comes as a tablet.
Fludarabine and cyclophosphamide can be given on their own, but are usually given together (as FC). They can be given as tablets or as an injection into a vein. A monoclonal antibody called rituximab may be given in combination with FC chemotherapy. This is called FCR or RFC treatment.
Bendamustine is sometimes used to treat SLL. It’s given as a drip into a vein (intravenously).
Monoclonal antibody therapy
Monoclonal antibodies are drugs designed to recognise certain proteins on the surface of cells. Monoclonal antibody treatments used for SLL are designed to destroy lymphocytes (B-cells and T-cells).
Rituximab (Mabthera ®)
Rituximab destroys B-cells. A nurse gives it as a drip into a vein (intravenous infusion). It is usually given with fludarabine and cyclophosphamide (as FCR).
Alemtuzumab (Campath ®)
Alemtuzumab destroys B-cells and T-cells. A nurse gives it as a drip into a vein (intravenous infusion) or as an injection under the skin (subcutaneous injection).
Steroids are drugs that can be used to treat SLL and to relieve chemotherapy-related sickness.
Stem cell treatment (transplants)
Some people with lymphoma may have treatments using their own stem cells or stem cells from a donor. Stem cells are early blood cells that develop into all the other types of blood cell. This treatment is not suitable for everyone and is not done routinely. Doctors take into account a person's general health and fitness when planning treatment.
Some people have some of their own stem cells collected and stored. This allows them to have higher doses of chemotherapy. After the chemotherapy, their stem cells are returned by a drip (like a blood transfusion) to help their blood cells recover from the effects of chemotherapy. This is called high-dose chemotherapy with stem cell support.
Some people may have treatment using stem cells from another person (a donor). This is called a donor (allogeneic) stem cell transplant.
Radiotherapy is the use of high-energy rays to destroy cancer cells, while causing as little harm as possible to healthy cells.
It may be used as a first treatment if the abnormal B-cells are contained in one or two groups of lymph nodes in the same part of the body (stage 1). In some people, this may cure the SLL.
Radiotherapy can also be used to treat lymphoma that has come back in one area of lymph nodes.