What are supportive treatments for chronic lymphocytic leukaemia (CLL)?

Supportive therapies are treatments that help control any symptoms caused by chronic lymphocytic leukaemia (also called CLL or CLL leukemia) or its treatment. This page explains the more common problems that some people with CLL have, and the treatments that can help.

Infections and chronic lymphocytic leukaemia (CLL)

People with CLL are more at risk of getting infections. This is because both CLL and the treatments used affect the immune system.

You can usually be treated for infections as an outpatient. But some infections can be life-threatening. If you get one of these, you will need to stay in hospital for treatment. It is important to contact your doctor or specialist nurse straight away for advice if you develop:

  • a cough
  • a sore throat
  • a fever or your temperature goes over 37.5°C (99.5°F)
  • any other sign of infection.

Your doctor may prescribe antibiotics, anti-viral drugs or anti-fungal drugs to help prevent or treat any infections during your treatment.

Related pages

Shingles and chronic lymphocytic leukaemia (CLL)

People with CLL are at a higher risk of developing an infection called shingles. This is an infection of a nerve and the area of skin around it. It is caused by the same virus that causes chickenpox. Anyone who has had chickenpox 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.

Effective treatment can prevent or limit the infection. Shingles usually gets better within 2 to 5 weeks.

Symptoms of shingles

The first symptom is often a tingling or burning feeling in the affected area. This is followed by pain and a red rash. This develops 2 to 3 days later.

Contact your GP or the hospital straight away if you:

  • think you have shingles
  • come into contact with someone who has shingles or chickenpox. 

Vaccine against shingles

People aged over 70 are routinely offered a vaccine against shingles. But it is not suitable for people with CLL, because it is a live vaccine. See below for more information about live vaccines. Your haematologist can give you more information about vaccines that are suitable for you.

Vaccinations and chronic lymphocytic leukaemia (CLL)

Your doctor may advise you to have vaccinations against illnesses such as flu and coronavirus. If you live with other people, your doctor may suggest they also have these vaccinations and any other regular vaccinations. Your doctors may also recommend 2 specific vaccines when you are first diagnosed with CLL. These are to protect against:

  • pneumonia
  • a type of infection called streptococcus.

Live vaccines and CLL

There are some types of vaccines that you should avoid. These are called live vaccines. They include flu vaccines that are given as a spray up the nose. If you have young children, they should not have this type of flu vaccine as it may affect you too.

Ask your doctor or specialist nurse for more advice about this before you have any vaccinations. It is important to get advice from your doctor if you are planning any travel abroad.

Low levels of antibodies and chronic lymphocytic leukaemia (CLL)

Many people with CLL have very low levels of infection-fighting antibodies (immunoglobulins) in their blood. This may mean they keep getting infections. Some people who are affected may need regular immunoglobulin treatment. A nurse gives the immunoglobulins:

  • as a drip (infusion) into a vein
  • as an injection under the skin.

Most people feel fine when they are having an immunoglobulin infusion, but sometimes it can cause a reaction. A reaction is more likely with the first infusion, so it is given more slowly.

Auto-immune reactions in chronic lymphocytic leukaemia (CLL)

CLL can sometimes cause the immune system to attack normal, healthy red blood cells or platelets.

If red blood cells are affected, this is called auto-immune haemolytic anaemia (AIHA). If platelets are affected, this is called immune thrombocytopenic purpura (ITP).

Auto-immune haemolytic anaemia (AIHA)

If you have AIHA, the number of red blood cells in the blood can fall very quickly. This can cause:

  • breathlessness
  • tiredness
  • a yellowish tinge to the whites of your eyes
  • dark-coloured urine (pee).

If you suddenly become very tired or breathless, contact the hospital straight away. You may need to have a blood test, and possibly treatment.

Immune thrombocytopenic purpura (ITP)

With ITP, the number of platelets in the blood can fall suddenly. This can cause:

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

If you have any of these symptoms, contact the hospital straight away for advice.

Transfusions and chronic lymphocytic leukaemia (CLL)

If your bone marrow is not making enough red blood cells or platelets, you may need to have a blood transfusion or platelet transfusion. You can have this as an outpatient.

If you are treated with fludarabine or bendamustine, you should only be given blood and platelet transfusions that have been treated with radiation (irradiated).

Irradiated transfusions should always be used during and after you have finished your treatment. This lowers the risk of the donated blood cells reacting against your own blood cells. Your hospital team should give you a card to carry, or a MedicAlert ID tag to wear. This is so hospital staff are aware of this if you ever need a blood transfusion in an emergency.

About our information

  • References

    Below is a sample of the sources used in our chronic lymphocytic leukaemia (CLL) information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Schuh A et al. Guideline for the treatment of chronic lymphocytic leukaemia. British Society for Haematology Guidelines. July 2018.

    Eichhorst B et al. Chronic lymphocytic leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. ESMO Guidelines Committee. October 2020.

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

  • use plain English
  • explain medical words
  • use short sentences
  • use illustrations to explain text
  • structure the information clearly
  • make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

Date reviewed

Reviewed: 01 February 2022
Next review: 01 February 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.