Oncology experts reflect on the evolution of the standard of care for chronic lymphocytic leukemia. CLL is one of the most common types of leukemia, diagnosed in adults. Recently, investigators have discovered molecules and proteins that target the underlying defect in CLL cells. Many advances in the laboratory have led to clinical trials that have resulted in marked benefit in many patients, including some who now have undetectable disease.
The Beginning of CLL Care
For many doctors, if there is one type of leukemia that you are going to get, then chronic lymphocytic leukemia (CLL) would be the one to get. It was often wrongly considered “lucky” or “good” when comparing types of cancers. Why? Because it progresses more slowly than other types of leukemia in most patients, but not all and many may die with the blood cancer and not because of it.
For the last half century, chemotherapy was the only way to manage this blood cancer. In the 1970’s half of all patients would have disease progression within the first year. By 2010, with better chemotherapy, it would be four years before patients progressed. “But we have evolved well past that today,” explains Su Young Kim, M.D., senior medical director, AbbVie. Dr. Kim, whose focus is oncology research and development, saw patients who were treated with chemotherapy early in his career. Through this approach, the cancer is attacked with the medicine going into the bloodstream, which can be useful for blood cancers that can progress like CLL. In some cases, doctors had used bone marrow transplants, but it’s use has become less common among oncologists in part due to the progress in more targeted medicines.
This approach was abandoned by doctors some time ago according to Michael Hallek, M.D., Department of Internal Medicine and Center of Integrated Oncology at the University Hospital of Cologne in Germany, who also described early care for CLL as frustrating. “Due to the nature of this leukemia many patients were dying from infections or refractory cases where they didn’t respond to treatment,” says Hallek. “Many doctors often found themselves simply relieving the symptoms for CLL patients.”