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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.
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.
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:
Low blood cell counts can cause:
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.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Boddy CS, Ma S. Frontline Therapy of CLL: Evolving Treatment Paradigm. Curr Hematol Malig Rep. 2018;13(2):69-77.
Cheson BD. What Is the Role of Chemotherapy in Patients With Chronic Lymphocytic Leukemia? Clin Lymphoma Myeloma Leuk. 2017;17(11):723-727.
Hallek M, Cheson BD, Catovsky D, et al. Guidelines for diagnosis, indications for treatment, response assessment and supportive management of chronic lymphocytic leukemia. Blood. 2018 Mar 14. pii: blood-2017-09-806398.
National Cancer Institute. Drugs Approved for Leukemia. May 19, 2017. Accessed at www.cancer.gov/about-cancer/treatment/drugs/leukemia on April 16, 2018.
National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 5.2018 -- March 26, 2018. Accessed at www.nccn.org/professionals/physician_gls/pdf/cll.pdf on April 16, 2018.
O'Reilly A, Murphy J, Rawe S, Garvey M. Chronic Lymphocytic Leukemia: A Review of Front-line Treatment Options, With a Focus on Elderly CLL Patients. Clin Lymphoma Myeloma Leuk. 2018;18(4):249-256.
Last Revised: May 10, 2018