Chemotherapy for Chronic Lymphocytic Leukemia

Chemotherapy (chemo) uses anti-cancer drugs that are taken by mouth or injected into a vein or muscle to kill or control cancer cells. When given this way, these drugs enter the bloodstream and reach all parts of the body, so chemo is useful for cancers that tend to spread throughout the body, like 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 seldom recommended for patients in poor health, but age itself should not keep anyone from getting chemo.

Chemo drugs used for CLL

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

Purine analogs: fludarabine (Fludara^®), pentostatin (Nipent^®), and cladribine (2-CdA, Leustatin^®). Fludarabine is often one of the first drugs used against CLL. (It's given along with cyclophosphamide and rituximab. This combination may be called FCR.)

Alkylating agents: chlorambucil (Leukeran^®), bendamustine (Treanda^®), and cyclophosphamide (Cytoxan^®). They're often given along with a monoclonal antibody.

Corticosteroids such as prednisone, methylprednisolone, and dexamethasone.

Possible side effects

Chemo drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells like 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 chemo, which can lead to side effects.

Chemotherapy side effects 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

Low blood cell counts can cause:

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

These side effects are usually short-term and go away once treatment is finished. There are often ways to lessen or even prevent these side effects. For instance, 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 them know when you do have side effects so they can be managed before they get worse.

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 help reduce the chance of infection, see Infections in People With Cancer.

Tumor lysis syndrome is another possible side effect of certain types of chemo. It's most common in patients who had large numbers of leukemia cells in the body before treatment. (This may be called bulky disease.) It most often happens with the first cycle of chemo. When the CLL 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 cause 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, febuxostat, and rasburicase.