Chronic Lymphocytic Leukemia (CLL): Chemotherapy

March 21, 2017

Chronic Lymphocytic Leukemia (CLL): Chemotherapy

What is chemotherapy?

Chemotherapy uses anticancer 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 after watchful waiting. Your doctor may advise chemo if you start to have symptoms or have signs that the 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 doctor'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 take these medicines in pill form, by injection, or IV. You may take 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. 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:

  • Fludarabine

  • Cladribine

  • Pentostatin

  • Chlorambucil

  • Cyclophosphamide

  • Doxorubicin

  • Vincristine

  • Bendamustine

You may have one medicine at a time, or a combination of medicines. In some cases chemotherapy medicines are combined with other medicines called targeted therapy. 

The medicines you get and how often you take them will depend on many factors. These factors include your overall health and the stage and type of your leukemia. The factors also include your age. For example:

  • If you're younger, your doctor may try fludarabine. You may take it as a single medicine. Or you may take it with rituximab or other medicines.

  • If you are older or have health problems, your doctor may give you a medicine that is likely to have fewer side effects. You may be given chlorambucil.

Your doctor may also give you steroids such as prednisone during your treatment. Prednisone helps fight a problem of CLL in which the immune system attacks the body’s own 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 quickly dividing normal cells. These include hair, and 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

  • Diarrhea

  • Tiredness, from having low levels of red blood cells

  • Hair loss

  • Headaches

  • Increased chance of infections, from low levels of white blood cells

  • Loss of sexual desire

  • Mouth sores

  • Nausea and vomiting 

  • Pain when swallowing 

Working with your healthcare provider

It's important to know which medicines you're taking. Write 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 to 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 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 medical team to make a plan to manage your side effects.


March 21, 2017


Selection of initial therapy for symptomatic or advanced chronic lymphocytic leukemia, Up To Date

Reviewed By:  

Alteri, Rick, MD,Cunningham, Louise, RN