Supportive therapy for chronic lymphocytic leukaemia

Infections

People with CLL are more at risk of getting serious infections|. This is because both CLL and the treatments for it affect the immune system, which fights infection.

Often infections can be treated as an outpatient but, 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.

Shingles

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 abdomen (tummy). 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 2–3 days later a red rash develops.

If you think you have shingles, or have come into contact with someone with 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 2–4 weeks.

Low level of antibodies

Some people with CLL have very low levels of infection-fighting antibodies (immunoglobulins) in their blood. Sometimes this can lead to problems with repeated infections. People who are affected may be given regular immunoglobulin treatment.

The immunoglobulins are given into a vein as an infusion (drip). 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.

Vaccines

Because of CLL your immune system isn’t as effective and vaccines may not work as well for you. But most people with CLL are 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 to avoid.

Autoimmune reactions in CLL

Sometimes CLL can cause the immune system to act against normal healthy red cells or platelets in the blood. If red cells are affected, this is called autoimmune haemolytic anaemia (AIHA). If platelets are affected, this is called immune thrombocytopenic purpura (ITP).

With AIHA the number of red cells in the blood 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 at once. You may need to have a blood test, and possibly treatment.

If the number of platelets suddenly drops this can cause bruising, sprinkles 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.

Transfusions

If your bone marrow isn’t making enough red cells or platelets you may need to have transfusions of blood or platelets. These can be done in the outpatients department.

We have more information about blood| and platelet transfusions|.