Supportive therapies

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

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.

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 immediately if you:

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

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

Vaccine against shingles

People over 70 are routinely offered a vaccine against shingles. But if you have CLL, this vaccine is not suitable for you because it is a live vaccine (see below). Your haematologist can give you more information about this.

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. This can feel similar to the reaction a monoclonal antibody infusion may cause. A reaction is more likely with the first infusion, so it is given more slowly.

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.