Loading
6 treatment settings, 5 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Observation; treat on symptoms, cytopenias, hyperviscosity or neuropathy, not on IgM level alone.
For low-risk prostate cancer, monitoring with PSA, MRI, and repeat biopsy instead of treating, because most such cancers never cause harm.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Bendamustine-rituximab or dexamethasone-rituximab-cyclophosphamide for fixed duration; or zanubrutinib / ibrutinib (± rituximab) continuously; plasmapheresis first for hyperviscosity.
An East German chemotherapy rediscovered in the 2000s that became the backbone partner for rituximab in follicular, mantle cell and Waldenström lymphomas.
Rituximab was the first antibody ever approved for cancer (1997). It made chemoimmunotherapy the CLL standard for a decade, and biosimilars keep it cheap and everywhere.
Zanubrutinib is the only BTK blocker to beat ibrutinib on both efficacy and safety in a head-to-head trial. It is now the most prescribed BTK inhibitor in CLL.
The pill that ended chemotherapy for most CLL. It blocks the survival signal B cells depend on, and it was the first drug to beat chemoimmunotherapy in nearly every CLL setting.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Infusion-related reactions (first infusion) · Historic lymphoma data; lower with premedication | 77% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Atrial fibrillation/flutter · ALPINE vs 13.3% ibrutinib | 5.2% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Atrial fibrillation · Pooled long-term CLL data; 5% grade ≥3 | 16% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Switch class (BTKi ↔ chemo-immunotherapy); bortezomib- or carfilzomib-based regimens; venetoclax; pirtobrutinib after covalent BTKi; autologous transplant in selected young patients.
Bortezomib was the first proteasome inhibitor: it jams the cell's protein-recycling machine, which antibody-factory plasma cells cannot tolerate.
Carfilzomib is a second-generation proteasome inhibitor with less nerve damage but more heart and blood-pressure effects.
A pill that removes the survival shield from leukaemia cells, enabling chemotherapy-free, time-limited treatment for CLL.
A BTK blocker that works after the older ones stop, because it grips a different part of the enzyme. Fully approved for CLL in December 2025.
Autologous stem cell transplant collects the patient's own blood-forming stem cells, gives melphalan or another chemotherapy at a dose that would otherwise destroy the marrow, then returns the cells to rebuild it. It is standard consolidation in myeloma and for relapsed lymphoma, though CAR-T has displaced it in early-relapsing large B-cell lymphoma.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Fatigue | 29% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
A lymphoplasmacytic lymphoma that secretes IgM. Two mutations, found by allele-specific PCR on a marrow aspirate, shape the whole plan. MYD88 L265P is present in more than 90 per cent and predicts response to BTK inhibitors; MYD88 wild-type disease responds much less well to them. CXCR4 mutations, present in about a third, predict slower and shallower responses to ibrutinib and a higher risk of a rise in IgM when treatment starts. Two complications need to be looked for because they change the urgency. Hyperviscosity, from a very high IgM, causes headache, blurred vision, nosebleeds and confusion, is confirmed on fundoscopy, and is treated with plasma exchange before anything else. IgM-related peripheral neuropathy, often anti-MAG positive, is a reason to treat even when other criteria are not met, because nerve damage does not reverse. Rituximab causes a transient rise in IgM, an IgM flare, in about half of patients, which can precipitate hyperviscosity; it is therefore held back or given after plasma exchange where the IgM is very high.
Rituximab was the first antibody ever approved for cancer (1997). It made chemoimmunotherapy the CLL standard for a decade, and biosimilars keep it cheap and everywhere.
The pill that ended chemotherapy for most CLL. It blocks the survival signal B cells depend on, and it was the first drug to beat chemoimmunotherapy in nearly every CLL setting.
Zanubrutinib is the only BTK blocker to beat ibrutinib on both efficacy and safety in a head-to-head trial. It is now the most prescribed BTK inhibitor in CLL.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Infusion-related reactions (first infusion) · Historic lymphoma data; lower with premedication | 77% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Atrial fibrillation · Pooled long-term CLL data; 5% grade ≥3 | 16% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Atrial fibrillation/flutter · ALPINE vs 13.3% ibrutinib | 5.2% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Treatment is for symptoms, not for a number: anaemia, thrombocytopenia, constitutional symptoms, symptomatic organ or node enlargement, hyperviscosity, neuropathy, cryoglobulinaemia or amyloidosis. An asymptomatic patient is watched. Two routes. Fixed-duration chemoimmunotherapy, usually bendamustine with rituximab for four to six cycles, gives deep responses and a treatment-free interval afterwards, and is the preference of many patients and many British units. Continuous BTK inhibition with zanubrutinib or ibrutinib gives high response rates without chemotherapy but is taken indefinitely. ASPEN, the only head-to-head trial, randomised 201 patients with MYD88-mutated disease to zanubrutinib or ibrutinib: the complete or very good partial response rate by independent review was 28.4 against 19.2 per cent, which did not reach statistical significance, but zanubrutinib caused markedly less atrial fibrillation, hypertension, bleeding and diarrhoea. A separate cohort treated MYD88 wild-type disease with zanubrutinib. Where a BTK inhibitor is chosen, zanubrutinib is therefore preferred. Rituximab with cyclophosphamide and dexamethasone is an alternative chemoimmunotherapy for patients in whom bendamustine is unsuitable. Proteasome-inhibitor regimens containing bortezomib are used where a rapid response is needed and neuropathy is absent.
Zanubrutinib is the only BTK blocker to beat ibrutinib on both efficacy and safety in a head-to-head trial. It is now the most prescribed BTK inhibitor in CLL.
The pill that ended chemotherapy for most CLL. It blocks the survival signal B cells depend on, and it was the first drug to beat chemoimmunotherapy in nearly every CLL setting.
An East German chemotherapy rediscovered in the 2000s that became the backbone partner for rituximab in follicular, mantle cell and Waldenström lymphomas.
Rituximab was the first antibody ever approved for cancer (1997). It made chemoimmunotherapy the CLL standard for a decade, and biosimilars keep it cheap and everywhere.
Cyclophosphamide is an alkylating chemotherapy that damages DNA in dividing cells. It is part of CHOP for lymphoma, AC for breast cancer and VAC for childhood sarcomas, clears lymphocytes before CAR-T and prevents graft-versus-host disease after transplant; bladder bleeding, infertility and secondary leukaemia are its harms.
Dexamethasone is a long-acting glucocorticoid steroid that kills lymphoid cancer cells directly, which is why it sits in nearly every myeloma regimen and in childhood leukaemia and lymphoma protocols. It is also the standard drug for preventing chemotherapy sickness and for brain swelling and spinal cord compression; high blood sugar, insomnia, muscle wasting and infection follow prolonged use.
Bortezomib was the first proteasome inhibitor: it jams the cell's protein-recycling machine, which antibody-factory plasma cells cannot tolerate.
Zanubrutinib did not significantly increase the complete or very good partial response rate over ibrutinib, but had markedly less cardiovascular and other toxicity; approved for Waldenström macroglobulinaemia in 2021.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Atrial fibrillation/flutter · ALPINE vs 13.3% ibrutinib | 5.2% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Atrial fibrillation · Pooled long-term CLL data; 5% grade ≥3 | 16% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Infusion-related reactions (first infusion) · Historic lymphoma data; lower with premedication | 77% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
The choice turns on what was used first and how long the remission lasted. After fixed-duration chemoimmunotherapy with a remission of two years or more, the same regimen can be repeated, or a BTK inhibitor started. After a BTK inhibitor, options are a different BTK inhibitor including the non-covalent pirtobrutinib, venetoclax, which has activity in this disease, proteasome-inhibitor regimens, chemoimmunotherapy if not previously used, and a clinical trial. Autologous transplant is occasionally used in younger patients with chemosensitive disease and multiple relapses. Transformation to diffuse large B-cell lymphoma is treated as aggressive lymphoma. Plasma exchange remains the immediate treatment for symptomatic hyperviscosity at any point.
Zanubrutinib is the only BTK blocker to beat ibrutinib on both efficacy and safety in a head-to-head trial. It is now the most prescribed BTK inhibitor in CLL.
The pill that ended chemotherapy for most CLL. It blocks the survival signal B cells depend on, and it was the first drug to beat chemoimmunotherapy in nearly every CLL setting.
A BTK blocker that works after the older ones stop, because it grips a different part of the enzyme. Fully approved for CLL in December 2025.
A pill that removes the survival shield from leukaemia cells, enabling chemotherapy-free, time-limited treatment for CLL.
Bortezomib was the first proteasome inhibitor: it jams the cell's protein-recycling machine, which antibody-factory plasma cells cannot tolerate.
An East German chemotherapy rediscovered in the 2000s that became the backbone partner for rituximab in follicular, mantle cell and Waldenström lymphomas.
Rituximab was the first antibody ever approved for cancer (1997). It made chemoimmunotherapy the CLL standard for a decade, and biosimilars keep it cheap and everywhere.
Autologous stem cell transplant collects the patient's own blood-forming stem cells, gives melphalan or another chemotherapy at a dose that would otherwise destroy the marrow, then returns the cells to rebuild it. It is standard consolidation in myeloma and for relapsed lymphoma, though CAR-T has displaced it in early-relapsing large B-cell lymphoma.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Atrial fibrillation/flutter · ALPINE vs 13.3% ibrutinib | 5.2% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Atrial fibrillation · Pooled long-term CLL data; 5% grade ≥3 | 16% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Fatigue | 29% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Infusion-related reactions (first infusion) · Historic lymphoma data; lower with premedication | 77% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.