Supportive or Palliative Care for Chronic Lymphocytic Leukemia

Supportive care for chronic lymphocytic leukemia (CLL) is aimed at helping with problems related to the cancer and its treatment. It's not treatment for the CLL itself. For instance, some people with CLL have problems with infections or low blood counts. Although treating the CLL may help these over time, other treatments may be needed in the meantime.

Treatments to prevent infections

Intravenous immunoglobulin (IVIG)

Some people with CLL don’t have enough antibodies (immunoglobulins) to fight infection. This can lead to repeated lung and/or sinus infections. Antibody levels can be checked with a blood test, and if they're low, antibodies from donors can be given into a vein (IV) to raise the levels and help prevent infections. These donated antibodies are called intravenous immunoglobulin or IVIG. IVIG is often given once a month at first, but can also be given as needed based on blood tests of antibody levels.

Antibiotics and anti-virals

Certain chemo drugs (such as purine analogs − see the chemotherapy section for details) and the antibody drug alemtuzumab(Campath) can raise your risk of certain infections such as CMV (a virus) and pneumonia caused by Pneumocystis jiroveci. You might be given an anti-viral drug like acyclovir or valacyclovir (Valtrex) to help lower the risk of CMV infections. To help prevent Pneumocystis pneumonia, a sulfa antibiotic is often given (trimethoprim with sulfamethoxazole, which is often known by the brand names Septra or Bactrim). Other treatments are available for people who are allergic to sulfa drugs.

Some drugs used to treat CLL can also cause dormant viruses to become active. For instance, if you already carry the hepatitis virus or CMV, treatment may allow them to grow and cause problems. Blood tests will be done to watch virus levels. Drugs may be used to help keep these viruses under control.

Using drugs to help prevent infections this way may be called anti-infective prophylaxis. Antibiotics and anti-viral drugs are also used to treat infections. Often, active infections require higher doses or different drugs than are used to prevent infections.

Vaccines

It's best for people with CLL to speak to their health care provider before getting any vaccine.

Experts recommend that people with CLL get the pneumonia vaccine every 5 years. They also recommend a yearly flu shot (influenza vaccine). 

Avoid vaccines that contain live viruses.

For more information on vaccines, see Vaccination and Flu Shots for People with Cancer.

Treatments for low blood counts

CLL or its treatment can cause low blood cell counts. Low red blood counts cause anemia. Anemia can make you feel tired, light headed, or short of breath from walking. If anemia is causing symptoms, it can be treated with transfusions. These are often given in an outpatient clinic. If platelet counts get very low, it can lead to serious bleeding. Platelet transfusions can help prevent this.

In CLL, low red blood and platelet counts can also be caused by the cells being destroyed by abnormal antibodies. When antibodies cause low numbers of platelets, it's called immune thrombocytopenic purpura or ITP. Before diagnosing this, the doctor often needs to check the bone marrow to make sure that there isn’t another cause for the low platelet counts. In ITP, giving platelet transfusions doesn’t usually help increase the platelet counts much, if at all, because the antibodies just destroy the new platelets, too. This can be treated by drugs that affect the immune system, like corticosteroids, IVIG, and the antibody drug rituximab (Rituxan). Another option is to remove the spleen, since after the antibodies stick to the platelets, they're actually destroyed in the spleen. Another option is a drug that tells the body to make more platelets, like eltrombopag (Promactac) or romiplostim (Nplate).

When antibodies cause low red blood cell counts, it's called autoimmune hemolytic anemia (AIHA). This also can be treated with drugs that affect the immune system, like corticosteroids, IVIG, and rituximab (Rituxan). Removing the spleen is another option. If you develop AIHA while taking fludarabine (Fludara), the drug may be the cause so it will be stopped.