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, so chemotherapy is useful for cancers such as leukemia that tend to 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:

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.

For information on infections and how to avoid them, see Infections in People With Cancer.

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 general information about chemotherapy, see the Chemotherapy section of our website.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: January 6, 2015 Last Revised: April 11, 2016

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