Chronic lymphocytic leukemia (CLL) treatment in Israel
What is leukemia?
Leukemia is a type of blood cancer. Leukemia is characterized by the uncontrolled proliferation of white blood cells. When a blood test is performed, a high count may be observed, referred to as:
WBC – WHITE BLOOD CELLS.
What is chronic lymphocytic leukemia – (CLL)?
It is the most common type of leukemia in the Western world. It is characterized by a chronic course that lasts for years in which there is the proliferation of a specific type of white blood cell called a lymphocyte.
What are the risk factors for the disease?
The disease usually appears in old age, and indeed the median age is 70 years, meaning that the first risk factor is age.
It is slightly more common in men than women and in Ashkenazi Jews.
Rarely, families with several relatives who have been diagnosed with CLL can be identified.
What are the symptoms of the disease?
In most cases, the disease is asymptomatic, with approximately 50% of cases diagnosed with a routine blood test performed at a health insurance company, and then an increase in white blood cells in general and, among them, lymphocytes is noted.
In other cases, the disease can appear with enlargement of lymph nodes, which can be enlarged simultaneously in several sites such as the neck, armpits, groin, etc. In addition, an enlargement of the spleen can occur, which is manifested by fullness or pain in the left abdomen.
Sometimes, if the bone marrow mainly produces leukemia cells and not other blood cells, anemia can appear, which is manifested by weakness, shortness of breath on exertion, or headaches. In general, the disease can cause weakness, sometimes also weight loss or night sweats.
How is chronic lymphocytic leukemia (CLL) diagnosed?
The diagnosis is made only by blood tests!
After identifying an increase in white blood cells in general and lymphocytes in particular in the blood count, the first step is to repeat the blood count and verify that this is indeed a permanent problem, and not a change caused by, for example, an infection.
If the blood count again demonstrates an increase in lymphocytes and white blood cells, a FACS-FLOWCYTOMETRY test is necessary – this test is necessary and responsible for an accurate diagnosis of the disease.
The purpose of the test is to prove that this is indeed the same leukemia cell that replicates itself = that is, it is monoclonal.
In this test, specific staining is performed for proteins that are expressed on the lymphocyte envelope and identifies whether it is indeed CLL.
What are the stages of the disease and what methods and stages are there?
According to the European system, there are 3 stages of the disease:
- BINET stage A – A- when there is only an increase in lymph nodes in less than 3 sites.
- BINET stage B – B- there is an increase in lymph nodes in more than 3 sites.
- BINET stage C – C- there is the appearance of anemia or a decrease in the number of platelets (thrombocytopenia).
What is transformation in the disease?
Rarely, the disease can change its nature from leukemia with a chronic course, to lymphoma with a faster course.
What are the treatments for chronic lymphocytic leukemia CLL?
It is not always necessary to treat CLL.
Only if the disease causes symptoms – treatment is recommended because sometimes it is possible to live with the disease without it actually affecting daily functioning and in this case – monitoring is recommended only.
When deciding to treat, the tendency today is to give biological treatments, administered partly as pills and partly intravenously.
Chemotherapy can still be considered in specific cases.
What levels of remission can be achieved from the treatments?
Complete remission can be achieved – meaning a decrease in the number of white blood cells to a normal value, accompanied by resolution of the anemia. In addition, the lymph nodes and spleen that were enlarged before treatment return to normal size.
Today, it is also possible to achieve a deeper response, which is called MRD – MINIMAL RESIDUAL DISEASE.
When the flow cytometry detects fewer than one leukemic cell per 10,000 cells examined – this indicates that MRD is negative – meaning there is no evidence of minimal residual disease.
What is the treatment according to the stages of the disease and what is the goal of the treatment?
CLL in the early stages – Watch and Wait – In the early stages of the disease, there is usually no need to treat, but only to monitor.
This is to prevent side effects, even if rare, in a person who could have lived well for many years, without symptoms even without treatment.
CLL in advanced stages:
In an advanced stage, when anemia, thrombocytopenia, or rapid or significant enlargement of lymph nodes and spleen occurs – then treatment is necessary.
Today, there are several treatment options that can be chosen according to each patient, their age, their underlying diseases, and their support network.
What is the chemical treatment for CLL (chemotherapy)?
The most common combinations are the combination of chemotherapy with immunotherapy.
Chemotherapy can be given in pills with a drug called Leukeran or chlorambucil, or intravenously with a drug called bendamustine, which is given for two consecutive days every month.
Or a combination of two drugs: fludarabine with cyclophosphamide, which are given for 3 consecutive days every 4 weeks.
This chemotherapy treatment is given in combination with a monoclonal antibody against the CD20 protein, this antibody can be Gazyva, Betaferon, Troxima, or Rixton.
What are the side effects of chemotherapy treatment for CLL?
Exposure to infections due to a decrease in white blood cells, sometimes to values that are even below normal.
What are the targeted therapies for chronic lymphocytic leukemia (CLL)?
A monoclonal antibody against the CD20 protein, which is expressed on the CLL cell.
This treatment is usually given intravenously in a day hospital or by subcutaneous injection. This treatment alone is not sufficiently effective and is therefore given in combination with another biological or chemotherapy drug.
There are currently several antibodies against CD20 and you can choose one of them:
- Rituximab (Mabthera®)*
- Rixton
- Troxima
- Ofatumumab (Arzerra®)*
- Obinutuzumab (Gazyva®)*
These are other targeted therapies available:
There are several biological drugs that are given in pills:
- BTK inhibitors – oral medications that target B-cell receptors to inhibit leukemia cell growth
There are several pills in this family:
- The first approved drug in this class was Ibrutinib (Imbruvica®)*
- Similar second-generation drugs are aclabrutinib or zanaibrutinib.
- The BCL2 inhibitor is a drug called Venetoclax (Venclexta®)**
- This is a drug taken in pills in increasing doses over the first 5 weeks, usually given in combination with a monoclonal antibody such as Gazyva.
What is supportive care?
Supportive care is to prevent infections by giving vaccines, sometimes giving antibody transfusions or giving blood and antibiotics.
Why Choose Israel for CLL Treatment?
Israel is internationally recognized for its excellence in medical innovation and oncology care. Patients diagnosed with chronic lymphocytic leukemia (CLL) have access to world-class treatments administered by leading hematologists and oncologists.
Key advantages of CLL treatment in Israel include:
- Access to cutting-edge therapies and clinical trials
- Personalized treatment plans using genomic analysis
- Leading cancer hospitals such as Sheba Medical Center and Ichilov Hospital
- English-speaking medical teams and modern patient facilities
Whether you are seeking initial diagnosis or advanced treatment options, Israel offers comprehensive care in state-of-the-art facilities with high success rates.
Take the First Step Toward Expert Care
If you or a loved one has been diagnosed with chronic lymphocytic leukemia (CLL), don’t wait to explore your treatment options in Israel. Contact our international patient services to schedule a consultation with top hematologists and oncology specialists. Our team is ready to provide personalized care, advanced diagnostics, and access to innovative treatments in world-renowned medical centers.
**Contact us today to begin your journey toward better health and healing.**