Drugs called purine analogs, which include fludarabine (Fludara), pentostatin (Nipent), and cladribine (2-CdA, Leustatin), may be used against CLL. Fludarabine seems to be the most effective single drug, and it is often the first drug used against CLL. These drugs can have major side effects, including an increased risk of infection.

Drugs called alkylating agents, which include chlorambucil (Leukeran) and cyclophosphamide (Cytoxan), have been around much longer. They are often used along with a purine analog or with other chemotherapy drugs. They may also be used by themselves (or along with a steroid drug), especially in people who can't tolerate more aggressive treatment.

Other drugs sometimes used for CLL include doxorubicin, vincristine, and prednisone.

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.

Chemotherapy Side Effects

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

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• lowered resistance to infection (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.

Be sure to talk with your cancer care team about any side effects you have because there are often ways to lessen them. For example, drugs can be given to prevent or reduce nausea and vomiting.

Drugs known as growth factors (G-CSF and GM-CSF, for example) 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 advise that you:

• 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. The most commonly used drugs are a combination of trimethoprim and sulfamethoxazole (Bactrim or Septra), which help fight bacteria. Drugs that help prevent viral and fungal infections may also be given.

Because many of the side effects of chemotherapy 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, don't hesitate to 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. Likewise, shortness of breath and extreme fatigue caused by low red blood cell counts may be treated with drugs or with red blood cell transfusions.