About chronic lymphocytic leukaemia (CLL) treatment

Chronic lymphocytic leukaemia (also called CLL or CLL leukemia) usually develops very slowly, so you may not need treatment for months or years. Some people never need treatment. Doctors usually wait until there are signs CLL is progressing before suggesting you have treatment.

The aim of treatment is to reduce the number of CLL cells to as few as possible. This is called remission. It is not usually possible to cure CLL, but it can be well controlled. Most people with CLL have long periods of time when they have a normal life with no symptoms. They may also have a normal life span.

Monitoring chronic lymphocytic leukaemia (CLL)

Only a small number of people with chronic lymphocytic leukaemia (CLL) need to start treatment straight away. If you have very early stage CLL, doctors usually wait until there are signs of progression before suggesting treatment. There is no evidence that starting treatment before this helps, and it can cause side effects.

Even if you are not having any treatment, you will see your haematologist or GP regularly for check-ups and blood tests. This is called monitoring (watch and wait).

Deciding when to start treatment for chronic lymphocytic leukaemia (CLL)

Stages of CLL and treatment

  • Stage A CLL

    If you have stage A CLL, you do not usually need treatment when you are diagnosed. It develops very slowly and often does not cause any symptoms. Some people with stage A CLL may never need treatment. You usually only start treatment if there are signs the CLL is progressing or you have certain symptoms.

  • Stage B CLL

    Some people with stage B CLL may not need treatment straight away. This depends on the signs and symptoms you have.

  • Stage C CLL

    If you have stage C CLL, you usually need treatment soon after being diagnosed. 

Reasons you may need treatment

If you have certain signs and symptoms, your doctors may decide you need treatment. These include:

  • very enlarged or fast-growing lymph nodes
  • a low level of red blood cells (anaemia) or platelet cells
  • heavy, drenching sweats, especially at night
  • weight loss
  • a high number of white blood cells that is increasing quickly.

Your doctor will check these symptoms are being caused by the CLL and not something else. This helps them decide whether to start your treatment.

Your doctor will also ask about your general health and check your fitness when planning your treatment. They can explain the benefits and disadvantages of treatment.

Before starting treatment, you will have some blood tests to check for the hepatitis B virus and HIV. These are routine tests before starting treatment for CLL. Your doctor will talk to you about these tests.

Types of treatment for chronic lymphocytic leukaemia (CLL)

Most people are treated with a combination of 2 types of treatment. These are:

Other treatments that are sometimes used include the following:

  • Supportive therapies

    You may have supportive therapies to help control any symptoms caused by CLL, such as infections or anaemia.

  • Donor stem cell transplant

    Doctors may suggest a stem cell transplant if the CLL has not responded to other treatments, or if it is a type of CLL that is unlikely to respond. It is only suitable for a small number of people. This is because it is an intensive treatment that can have serious side effects.

  • Radiotherapy

    Radiotherapy is only used in certain situations. For example, you may have it if you have enlarged lymph nodes or an enlarged spleen. 

  • Steroids

    You may have treatment with steroids if the number of red blood cells in the blood falls very quickly, because of a condition called auto-immune haemolytic anaemia (AIHA). Sometimes, people have high-dose steroid treatment called high-dose methylprednisolone (HDMP). With HDMP, you can have the steroids as tablets or as a drip into a vein. The steroids most commonly used to treat CLL include:

    • dexamethasone
    • methylprednisolone
    • prednisolone.
  • Surgery

    This is sometimes used to remove an enlarged spleen (splenectomy).

There are many new treatments being developed to improve the outcomes for people with CLL. You may be invited to take part in a clinical trial of one of these treatments. Ask your doctor about any clinical trials you could join.

We understand that having treatment can be a difficult time for people. We're here to support you. If you want to talk, you can:

Types of remission in chronic lymphocytic leukaemia (CLL)

There are different levels of remission:

  • Complete remission (CR) – no CLL cells or enlarged lymph nodes can be found by standard tests and scans.
  • Partial remission (PR) – there are still CLL cells in the blood or bone marrow, but their number has reduced, and the lymph nodes are smaller.

Some people who are in complete remission may have what is called minimal residual disease (MRD). This means that there are so few CLL cells remaining that they can only be found with special tests on the blood and bone marrow.

For most people, treatment is very successful at getting the leukaemia into complete or partial remission. This may last for years.

If CLL does not respond well to the first treatment, your doctors can change the treatment. There are many different treatment options available for CLL.

When the leukaemia starts to grow again and cause problems, you can have more treatment to put CLL back into remission. This can be done several times.

If treatments to control CLL do not work, or stop working, you can have supportive therapy to manage symptoms.

About our information

  • References

    Below is a sample of the sources used in our chronic lymphocytic leukaemia (CLL) information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Schuh A et al. Guideline for the treatment of chronic lymphocytic leukaemia. British Society for Haematology Guidelines. July 2018.

    Eichhorst B et al. Chronic lymphocytic leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. ESMO Guidelines Committee. October 2020.

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

  • use plain English
  • explain medical words
  • use short sentences
  • use illustrations to explain text
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

Date reviewed

Reviewed: 01 February 2022
Next review: 01 February 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.