Leukemia--Chronic Lymphocytic

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Treating Leukemia - Chronic Lymphocytic (CLL) TOPICS

Supportive care for chronic lymphocytic leukemia

Patients with chronic lymphocytic leukemia (CLL) often benefit from care aimed at helping with problems related to the CLL and its treatment. For example, some patients with CLL have problems with infections or low blood counts. Although treating the CLL may help these over time, other therapies may be needed as well.

Treatments to prevent infections

Intravenous immunoglobulin (IVIG)

Some patients with CLL have low levels of their own antibodies (immunoglobulins) to fight infection. This can lead to problems with lung and/or sinus infections that keep coming back. The level of antibodies in the blood can be checked with a blood test, and if it is low, antibodies from donors can be given into a vein (IV) to raise the levels and help prevent infections. This is called intravenous immunoglobulin or IVIG. IVIG is often given once a month at first, but may be able to be given less often based on blood tests of antibody levels.

Antibiotics and anti-virals

Patients getting certain chemotherapy drugs (such as purine analogs − see the chemotherapy section for details) and the antibody drug alemtuzumab (Campath) have a high risk of infections seen mainly in people with impaired immune systems, like infection with CMV (a virus) and pneumonia caused by Pneumocystis jiroveci. An anti-viral drug like acyclovir is often given to try to prevent 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® and Bactrim®). Other treatments are available for people who are allergic to sulfa drugs.

Antibiotics and anti-viral drugs are also given to treat infections. Often, active infections require higher doses or different drugs than are used to prevent infections.

Vaccines

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

Vaccines that contain live viruses, such as the shingles vaccine (herpes zoster vaccine) should be avoided.

For more information on infections, including vaccines, see our document Infections in People With Cancer.

Treatments for low blood counts

Some patients develop low red blood cell counts (anemia) from CLL or its treatment. This can lead to patients feeling tired, light headed, or short of breath from walking. Anemia that is causing symptoms can be treated with transfusions. These are often given on an outpatient basis.

If platelet counts get very low, it can lead to serious bleeding. Transfusing platelets 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 is called immune thrombocytopenia. 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 immune thrombocytopenia, 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 are actually destroyed in the spleen. Another option is a drug that tells the body to make more platelets, like eltrombopag (Promacta®) or romiplostim (Nplate®).

When antibodies cause low red blood cell counts, it is 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 also an option. If the patient was on fludarabine (Fludara) when the AIHA developed, the drug may be the cause, and so the fludarabine will be stopped.


Last Medical Review: 07/31/2013
Last Revised: 04/18/2014