Supportive therapies for CLL

People with CLL are at risk of serious infections. Contact your doctor straight away if you have any signs of infection including:

  • a cough
  • a sore throat
  • fever
  • tingling, pain and a red rash on one side of your; chest, tummy, head or face (this could be shingles).

You may be given vaccines to help prevent infections such as flu. But, people with CLL shouldn’t have live vaccines, if in doubt check with your haematologist.

Some people who get repeated infections are treated with infection fighting antibodies called immunoglobulins.

In some people with CLL the immune system attacks their red blood cells or platelets. This can cause symptoms to appear very quickly. Contact your doctor if you have symptoms such as:

  • sudden tiredness
  • breathlessness
  • dark urine
  • yellowish ‘whites’ of your eyes
  • easy bruising
  • purple-red dots on your legs or arms
  • unusual bleeding from the gums
  • a severe nosebleed.

If your red cells or platelets are low you may need to have a transfusion of blood or platelets.

Supportive therapy

Supportive therapies are treatments that help to control any symptoms caused by CLL or its treatment. 


Infections

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.

You can usually be treated for infections as an outpatient. However, more serious infections can be life-threatening. It’s important to contact your doctor for advice straight away if you develop a cough, sore throat, fever 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. It’s caused by the same virus that causes chickenpox. Anyone who has had chickenpox before 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). A nerve in the face can also be affected, but this is less common.

The first symptom is often a tingling sensation in the affected area. This is followed by pain and a red rash which develops 2 to 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 can prevent or limit the infection. Shingles usually gets better within 2 to 5 weeks.

People over 70 are routinely offered a vaccine against shingles. But if you have CLL, you will need to talk to your haematologist before you have the vaccine. It’s not usually safe for people with CLL to have it, because it is a live vaccine.

Vaccines

Having CLL can mean your immune system isn’t as effective as before, and vaccines may not work very well for you. But most people with CLL are still advised to have a yearly flu vaccine. This is to give them as much protection as possible. Your doctors may also recommend two specific vaccines when you are first diagnosed. These are to protect against pneumonia and a type of infection called streptococcus.

There are some types of vaccines that you should avoid. For example, live vaccines. Live vaccines contain a weak, altered form of the live virus. People with CLL have a weakened immune system, so the vaccine may cause them harm. Your haematologist can tell you which vaccinations are safe and if there are any you should avoid.

Low levels of immunoglobulins

Most people with CLL have very low levels of infection-fighting antibodies (immunoglobulins) in their blood. This can sometimes 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 it can cause a reaction similar to the reaction a monoclonal antibody infusion may cause. This is most likely to happen with the first infusion. To reduce the chance of a reaction, the first infusion is given slowly.


Autoimmune reactions in CLL

CLL can sometimes cause your immune system to act against normal, healthy red blood cells or platelets. If red blood 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 blood cells falls very quickly. This may cause:

  • breathlessness
  • tiredness
  • a yellowish tinge to the whites of your eyes
  • 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.

When the number of platelets suddenly drops, it can cause:

  • bruising
  • areas of dark, purple-red dots on the shins or arms
  • unusual bleeding from the gums
  • a nosebleed that takes a long time to stop.


Transfusions

‘They were giving me blood every couple of weeks to sort of boost me. I’d feel like a new man with three pints of blood running round my veins.’ Ash

Ash

Back to Supportive therapies

Blood transfusions

Some cancers or cancer treatments can cause anaemia, which is a low number of red blood cells. Blood transfusions are used to treat anaemia.

G-CSF

Having chemotherapy can make you more prone to infections. G-CSF helps you make more white blood cells to reduce that risk.

Platelet transfusions

Platelets are cells that help to stop bleeding. Some cancers or cancer treatments can lead to low platelets and you may need a platelet transfusion.

Steroids

Steroids can be used as part of cancer treatment or to help with the side effects of treatment.