Chemotherapy for chronic lymphocytic leukaemia (CLL)
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy or damage leukaemia cells.
The drugs can be given as tablets (oral chemotherapy) or into a vein (intravenously). The chemotherapy circulates in your blood and can reach leukaemia cells all over the body.
You may have either a single chemotherapy drug or a combination of two or more different drugs given together. Chemotherapy for CLL can usually be given to you as an outpatient.
Before starting chemotherapy, you will have your height and weight checked. This is used to work out the right dose of chemotherapy for you. Chemotherapy is usually given as several sessions of treatment. Each treatment is followed by a rest period of a few weeks. This allows your body to recover from any side effects. The treatment and the rest period together make up a cycle of treatment.
The drugs most often used to treat CLL are:
Chlorambucil chemotherapy is given as tablets. They can be prescribed in different ways, depending on your needs.
Fludarabine and cyclophosphamide are usually given together (known as FC). The treatment can be given as tablets or intravenously. A monoclonal antibody called rituximab may be given in combination with FC chemotherapy. This is called FC-R or R-FC treatment.
Fludarabine may be given on its own to people who have previously had chlorambucil and who need further treatment when CLL returns. It’s most likely to be given to people who aren’t fit enough to cope with the possible side effects of two chemotherapy drugs combined.
Bendamustine may be given to people with stage B or stage C CLL who might not be able to have fludarabine.
Sometimes, a combination of the chemotherapy drugs cyclophosphamide, vincristine and doxorubicin are given together. This is called CHOP chemotherapy and it’s given intravenously. Steroid tablets called prednisolone are taken for five days with each cycle of treatment. Other drugs and combinations of drugs may be used.
Your doctor will tell you what treatment they recommend for your situation.
If you’re taking a single chemotherapy drug, such as chlorambucil, any side effects you have will usually be mild. Treatment with a combination of two or more chemotherapy drugs may cause more troublesome side effects.
Risk of infection
Chemotherapy destroys the leukaemia cells in your blood, but it also temporarily reduces the number of healthy white blood cells. Your blood cell levels will be checked regularly while you’re having treatment. If your white blood cell count is too low, you are more at risk of infection and your treatment may be delayed for a while to allow it to recover.
While having chemotherapy, you should contact your doctor or the hospital straight away if you:
have a temperature above 38˚C (100.4˚F)
suddenly feel unwell (even with a normal temperature)
have other signs of infection, such as coughing up sputum.
If you develop an infection, you may need to go into hospital for treatment. If the antibody levels in your blood are very low, you may be given antibodies (immunoglobulins) through an intravenous drip.
Your doctor may prescribe medicines to help prevent infection.
If you’re being treated with fludarabine you may be given drugs to help prevent viral and fungal infections while you’re taking it.
You may also need to take antibiotics for up to a year after fludarabine treatment to help prevent chest infections.
Watch our slideshow with tips to help you to avoid infection while your immunity is low.
Anaemia, bruising and bleeding
Chemotherapy can lower the number of red cells and platelets in the blood:
A low red blood cell count is called anaemia and can cause tiredness and breathlessness.
A low platelet count can cause blood clotting problems and you may have bruising, nosebleeds or other abnormal bleeding. You should check for blood blisters in your mouth or a rash of pinprick-sized red spots on your legs (petechiae).
If your red blood cells or platelets take a while to recover, you may need a blood transfusion or a platelet transfusion. You can have transfusions as an outpatient.
Anyone who has been treated with fludarabine should only be given blood and platelet transfusions that have been treated with radiation (irradiated). Irradiated transfusions should be used indefinitely. This lowers the risk of the donated blood cells reacting against your own. Your hospital team should give you a card to carry or a MedicAlert ID tag to wear so that hospital staff are aware in case of an emergency.
Some of the chemotherapy drugs used may make people feel sick (nauseous) or even be sick (vomit). This can be helped by taking anti-sickness drugs (anti-emetics), which your doctor can prescribe. If they don’t work for you, let your doctor know as there are different drugs that can be used.
Some chemotherapy drugs can make your mouth sore and cause small ulcers. You may be given a mouthwash to use regularly. Your nurse will explain how to use it. If your mouth is sore, it’s best to avoid alcohol and foods that are very hot, salty or highly spiced.
If you’re having treatment with two or more chemotherapy drugs, or chemotherapy over a long period of time, you will probably feel more tired than usual. If you feel tired, plan some rest periods into your day. Try to balance rest periods with some gentle activities (such as walking) when you feel able.
Losing your hair
Not all chemotherapy drugs cause hair loss. Whether you lose any hair during your treatment will depend on the treatment you have. Your doctor or chemotherapy nurse can tell you what to expect. Treatment with chlorambucil or FC chemotherapy doesn’t usually cause hair to fall out completely, although it may become thinner.
CHOP chemotherapy usually causes complete hair loss. This is temporary and your hair will start to grow back once you’ve finished treatment.
If you’re concerned about whether you will be able to have children after your treatment, it’s important to discuss this with your doctor before treatment starts. Some of the drugs used to treat CLL can cause temporary or permanent infertility.
If you have high-dose chemotherapy or radiotherapy before a stem cell or bone marrow transplant, you are likely to become permanently infertile. Men may be able to have sperm stored before they start treatment (sperm banking) and women may be able to have eggs collected and frozen. It’s important to speak to your medical team about this before your treatment begins.
Men who could possibly father a child, or women who may become pregnant, should use contraception throughout their treatment, and for six months afterwards. This is because chemotherapy could cause harm to a baby conceived during this time.
Your doctor will be able to answer any questions you have about the effect treatment is likely to have on your fertility.
We have further information about fertility in our section on cancer treatment and fertility.