Leukemia--Chronic Lymphocytic

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Treating Leukemia - Chronic Lymphocytic (CLL) TOPICS

Chemotherapy for chronic lymphocytic leukemia

Chemotherapy (chemo) uses anti-cancer drugs that are taken by mouth or injected into a vein or into a muscle to destroy or control cancer cells. When given this way, these drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancers such as leukemia that spread throughout the body.

When treating certain types of leukemia, chemo may also be injected into the cerebrospinal fluid. Chemo given into the CSF is often the best way to treat leukemia in the area around the brain and spinal cord. This type of chemo, called intrathecal chemotherapy, is rarely needed to treat chronic lymphocytic leukemia (CLL).

Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemo cycles generally last about 3 to 4 weeks. Chemo is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemo.

The major types of chemo drugs used to treat CLL include:

Purine analogs include fludarabine (Fludara®), pentostatin (Nipent®), and cladribine (2-CdA, Leustatin®). Fludarabine is often one of the first drugs used against CLL. These drugs can have major side effects, including an increased risk of infection.

Alkylating agents, which include chlorambucil (Leukeran®) and cyclophosphamide (Cytoxan®), have been around much longer. They are often used along with a purine analog, with other chemo drugs, with a corticosteroid, or with the monoclonal antibody rituximab (Rituxan®).

A newer drug called bendamustine (Treanda®) is an alkylating agent that has some properties of a purine analog.

Corticosteroids such as prednisone, methylprednisolone, and dexamethasone.

Other drugs sometimes used for CLL include doxorubicin (Adriamycin®), methotrexate, oxaliplatin, vincristine (Oncovin®), etoposide (VP-16), and cytarabine (ara-C).

Possible side effects

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. Common side effects include:

  • Hair loss
  • Mouth sores
  • Loss of appetite
  • Nausea and vomiting
  • Low blood counts

Chemo can affect bone marrow, leading to low blood cell counts. This can cause:

  • Increased risk of infections (due to low white blood cell counts)
  • Easy bruising or bleeding (due to low blood platelets)
  • Fatigue (due to low red blood cells)

These side effects are usually short-term and go away once treatment is finished. There are often ways to lessen these side effects. For example, there are drugs to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects, and let him or her know when you do have side effects so they can be managed effectively.

Drugs known as growth factors (such as G-CSF/Neupogen®, pegfilgrastim/Neulasta®, and GM-CSF/sargramostim) are sometimes given to increase the white blood cell counts and thus reduce the chance of infection.

If your white blood counts are very low during treatment, you can reduce your risk of infection by carefully avoiding exposure to germs. During this time, your doctor may tell you to:

  • Wash your hands often.
  • Avoid fresh, uncooked fruits and vegetables and other foods that might carry germs.
  • Avoid fresh flowers and plants because they may carry mold.
  • Make sure other people wash their hands when they come in contact with you.
  • Avoid large crowds and people who are sick (wearing a surgical mask offers some protection in these situations).

Antibiotics may be given before there are signs of infection or at the earliest sign that an infection may be developing. Drugs that help prevent viral and fungal infections may also be given. For more information on infections and how to avoid them, see our document Infections in People With Cancer.

Because many of the side effects of chemo are caused by low white blood cell counts, some people find it helpful to keep track of their counts. If you are interested in this, ask your doctor or nurse about your blood cell counts or other blood tests and what these numbers mean.

If platelet counts are low, you may be given drugs or platelet transfusions to help protect against bleeding. Shortness of breath and extreme fatigue caused by low red blood cell counts may be treated with drugs or with red blood cell transfusions.

Tumor lysis syndrome is another possible side effect of chemo. It is most common in patients who had large numbers of leukemia cells in the body before treatment and occurs most often with the first cycle of chemo. When the cells are killed, they break open and release their contents into the bloodstream. This can overwhelm the kidneys, which cannot get rid of all of these substances at once. This can lead to build up of excess amounts of certain minerals in the blood and even kidney failure. The excess minerals can lead to problems with the heart and nervous system. Doctors work to prevent these problems by giving the patient extra fluids and certain drugs, such as sodium bicarbonate, allopurinol, and rasburicase.

For more information about any individual drug used for CLL treatment, please see our Cancer Drug Guide. For more general information about chemotherapy, please see our document, Understanding Chemotherapy: A Guide for Patients and Families.

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