Supportive therapy for chronic lymphocytic leukaemia (CLL)
Supportive therapies are treatments which help to control any symptoms caused by chronic lymphocytic leukaemia (CLL) or its treatment. This section explains the more common problems that some people with CLL may experience and the treatments that can help.
People with CLL are more at risk of getting serious infections. This is because both CLL and the treatments used for it affect the immune system, which fights infection.
Often, infections can be treated as an outpatient. However, because more serious infections can be life-threatening, it’s important that you contact your doctor for advice straight away if you develop a cough, sore throat or any other sign of infection.
Tips for avoiding infection
Watch our slideshow with tips to help you to avoid infection while your immunity is low.
People with CLL are at a higher risk of developing an infection called shingles. The infection affects a nerve and the area of skin around it, and is caused by the same virus that causes chickenpox. Anyone who has had chickenpox in the past may develop shingles.
The virus usually affects one nerve in one area of the body. The most common areas to be affected are one side of the chest, or one side of the tummy (abdomen). Less commonly, a nerve in the upper face (including the eye) may be affected.
The first symptom is often a tingling sensation in the affected area. This is followed by pain and a red rash that develops 2-3 days later.
If you think you have shingles, or you have come into contact with someone who has shingles or chickenpox, it’s important to contact your GP or the hospital immediately. Effective treatment is available to prevent or limit the infection. Shingles usually gets better within 2-5 weeks.
Low levels of antibodies
Most people with CLL have very low levels of infection-fighting antibodies (immunoglobulins) in their blood. Occasionally, this can lead to problems with repeated infections. Some people who are affected may need to be given regular immunoglobulin treatment. The immunoglobulins are given into a vein as a drip (infusion) or as an injection under the skin (subcutaneously).
Most people feel fine when having an immunoglobulin infusion, but sometimes the infusion can cause a reaction similar to one that may be caused by alemtuzumab. This is most likely to happen with the first infusion. To reduce the chance of a reaction, the first infusion is given slowly.
Having CLL can mean your immune system isn’t as effective as before, and vaccines may not work as well for you. However, most people with CLL are still advised to have a yearly flu vaccination, to give them as much protection as possible. There are some types of vaccines, such as ‘live’ vaccines, that you should avoid. Your haematologist can tell you which vaccinations are safe and if there are any you should avoid.
Autoimmune reactions in CLL
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Sometimes, CLL can cause the immune system to act against normal healthy red blood cells or platelets in the blood. If red blood cells are affected, this is called autoimmune haemolytic anaemia (AIHA). If platelets are affected, this is called immune thrombocytopenic purport (ITP).
With AIHA, the number of red blood cells falls rapidly. This may cause breathlessness, tiredness, a yellowish tinge to the whites of your eyes and dark-coloured urine. If you suddenly become very tired or breathless, contact the hospital straight away. You may need to have a blood test, and possibly treatment.
If the number of platelets suddenly drops, this can cause bruising, areas of dark, purplish-red dots on the shins or arms, unusual bleeding from the gums, or a nosebleed that takes a long time to stop.
Steroids are usually the main treatment for these problems.
If your bone marrow isn’t making enough red blood cells or platelets, you may need to have blood transfusions or platelet transfusions. These can be done in the outpatients department.