Chronic Lymphocytic Leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is the most common type of adult leukemia in the United States. The average age at diagnosis is around 72, and it is extremely rare in children or young adults. 

CLL usually progresses slowly, and many people live for years without symptoms or needing treatment. Still, some cases can be more aggressive and need treatment earlier. 

 At Columbia, our team of CLL experts provides individualized care for every stage of CLL. With access to advanced diagnostics, novel therapies, and clinical trials available at only a few centers nationwide, you’ll benefit from the latest science—driven by Columbia’s own physician-researchers. 

What is chronic lymphocytic leukemia (CLL)?

CLL is a cancer of the blood and bone marrow that develops from B lymphocytes—a type of white blood cell that plays an essential role in the immune system. In CLL, a single B cell undergoes a genetic mutation in the bone marrow, becoming cancerous and multiplying uncontrollably. These abnormal cells, known as CLL cells, gradually build up in the blood, bone marrow, lymph nodes, and spleen. 

Unlike healthy B cells, CLL cells do not function properly. Over time, their accumulation can weaken the immune system, reduce the number of healthy blood cells, and cause complications like anemia, infections, or bleeding problems. 

Our team at Columbia uses advanced molecular and genetic testing to understand the exact nature of your leukemia. This information helps predict how your CLL may behave and guides your personalized treatment plan. 

What are CLL symptoms?

CLL is often diagnosed incidentally through routine bloodwork before symptoms appear. When symptoms do develop, they may include: 

• Swollen lymph nodes, especially in the neck, underarms, or groin 
• Frequent infections 
• Fatigue 
• Night sweats or fevers 
• Unexplained weight loss 

How is CLL diagnosed?

An accurate diagnosis is the foundation of effective care. At Columbia, we use a range of specialized tests to diagnose and understand your CLL so that we can give you the best treatment options. Some of the tests may include: 

• Complete blood count (CBC): Measures levels of red cells, white cells, and platelets 
• Flow cytometry: Confirms the presence of CLL cells by analyzing surface proteins 
• Bone marrow biopsy: May be used to assess disease involvement or guide treatment 
• FISH and karyotyping: Identify chromosome abnormalities that influence prognosis 
• DNA sequencing: Detects mutations like TP53 that affect treatment planning 

From the moment of diagnosis, we provide you with detailed information to help you understand your disease and make informed choices about your care. 

How is CLL treated?

Treatment for CLL is not one-size-fits-all. Many people with early-stage CLL and no significant symptoms may not need treatment right away. This approach, called watchful waiting or active surveillance, includes regular monitoring to detect changes in your condition. 

When treatment is needed, Columbia offers the latest therapies backed by leading research and clinical expertise. 

Our CLL treatment options include: 

• Targeted therapies, oral medications that interfere with the signaling pathways that CLL cells use to grow. These include kinase inhibitors (like acalabrutinib and zanubrutinib) and BCL-2 inhibitors (like venetoclax), often used as first-line or second-line treatments. 
• Monoclonal antibodies, lab-designed proteins that help your immune system find and destroy leukemia cells. Medications such as obinutuzumab or rituximab are often given with targeted drugs to enhance effectiveness. 
• Cellular therapies. For eligible patients, we offer CAR T-cell therapy, a cutting-edge treatment that reprograms your own immune cells to attack CLL. 
• Clinical trials. At Columbia, you may have access to clinical research studies exploring the next generation of therapies for CLL.

As a chronic type of leukemia, CLL often requires more than one treatment. Our experts are on top of – and leading – some of the latest research into which therapies are the most effective at each stage and with each unique aspect of CLL.  We develop your care plan with a full team of experts, including hematologists, oncologists, pathologists, and clinical researchers—ensuring your care is coordinated, comprehensive, and informed by the latest science. 

Clinical trials for CLL

At Columbia, we’re committed to advancing the future of CLL treatment. Our clinical research program offers access to a wide range of trials for people with newly diagnosed CLL, relapsed or refractory disease, and those experiencing Richter’s transformation—an aggressive evolution of CLL into lymphoma. 

Participating in a clinical trial may give you access to promising new therapies, including: 

• Next-generation BTK inhibitors and degraders 
• Bispecific antibodies that target CLL cells in new ways 
• Innovative combinations and dosing strategies designed to improve CLL outcomes 

We’ll help determine whether a trial is right for you and guide you through every step. Our goal is to ensure that each patient has access to the most advanced options available—today and in the future.