Chronic Lymphocytic Leukemia (CLL): Chemotherapy
What is chemotherapy?
Chemotherapy uses strong medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.
When might chemotherapy be used for CLL?
For chronic lymphocytic leukemia (CLL), chemotherapy is usually the first treatment used after watchful waiting. Your healthcare provider may suggest chemo if you start to have symptoms or have signs that your leukemia is getting worse. Chemotherapy is not likely to cure CLL. But it can often help keep it under control. Even if the leukemia is very advanced, chemotherapy may help ease symptoms. This can improve your quality of life.
How is chemotherapy given for CLL?
Most people have chemotherapy in an outpatient part of the hospital, at a healthcare provider's office, or at home. In some cases, you may need to stay in the hospital during treatment. This will depend on the medicines you are given and your overall health. You may get these medicines in pill form, by injection, or through a small, flexible tube called an IV that is put into a vein. You may get the medicines in more than one of these ways.
You get chemotherapy in cycles over a period of time. That means you may take the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is one cycle. You may have several cycles. Having treatment in cycles helps by:
Killing more cancer cells. The medicine can kill more cancer cells over time, because the cells aren't all dividing at the same time. Cycles allow the medicine to fight more cells.
Giving your body a rest. Treatment is hard on other cells of the body that divide quickly. This includes cells in the lining of the mouth and stomach. This causes side effects, such as sores and nausea. Chemotherapy can also cause a drop in healthy blood cells. Between cycles, your body can get a rest from the chemotherapy.
Giving your mind a rest. Having chemotherapy can be stressful. Taking breaks between cycles can let you get an emotional break between treatments.
What are the medicines used to treat CLL?
The medicines used most often for CLL include:
You may get one medicine at a time, or a combination of medicines. Chemotherapy medicines are often combined with other medicines called targeted therapy.
The medicines you get and how often you get them will depend on many factors. These factors include your overall health, the genetic changes seen in the CLL cells, and the stage of your leukemia. The factors also include your age. For example, if you are older or have other major health problems, you healthcare provider may give you a medicine that is likely to have fewer side effects.
Your healthcare provider may also give you medicines called steroids, such as prednisone or dexamethasone, during your treatment. This is done to help fight a problem of CLL in which the immune system attacks the body’s own healthy red blood cells or platelets.
What are common side effects of chemotherapy?
Chemotherapy medicines are designed to attack and kill cells that divide quickly, including cancer cells. These medicines can also affect normal cells that divide quickly. These include hair follicles, the lining of the intestines and mouth, and the bone marrow cells where new blood cells are made. The side effects of chemotherapy are different for everyone. They usually go away when the treatment ends.
The most common short-term side effects of chemotherapy include:
Loss of appetite
Easy bruising or bleeding, from low levels of blood platelets
Tiredness (fatigue), from having low levels of red blood cells
Increased chance of infections, from low levels of white blood cells
Loss of sexual desire
Nausea and vomiting
Pain when swallowing
Working with your healthcare provider
It's important to know which medicines you're taking. Write down your medicines down. Ask your healthcare team how they work, and what side effects they might have.
Talk with your healthcare providers about what signs to look for, and when you should call them. Make sure you know what number to call with questions, even on evenings and weekends.
It may be helpful to keep a diary of your side effects. Write down any physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.
June 14, 2018
NCCN Clinical Practice Guidelines in Oncology: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. National Comprehensive Cancer Network
LoCicero, Richard, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS