Supportive treatments for chronic lymphocytic leukaemia (CLL)

Chronic lymphocytic leukaemia (CLL) and its treatment can cause problems. Supportive treatments can help to either prevent or control these problems.  

The problems or symptoms you have depend on how the CLL is affecting your body. And it also depends on what treatment you have.

You might have some of the following supportive treatments:

• medicines to treat or prevent infections, such as some vaccines
• blood products
• painkillers
• treatment for autoimmune conditions

Treating infections

CLL and its treatment affect your immune system . So you are more at risk of getting infections.

It’s important to tell your hospital treatment team urgently if you have any signs of infection.

Symptoms include:

• a change in temperature
• aching muscles
• headaches
• feeling cold and shivery and generally unwell

You might have other symptoms depending on where the infection is.

For some infections you can have treatment at home. But other infections can be life threatening, and you will need treatment in hospital.

Treatment for infection includes:

• antibiotics which treat bacterial infections
• antiviral drugs which treat viral infections
• antifungal drugs which treat infection caused by a fungal infection

Preventing infections

Medicines to prevent infection

Doctors sometimes suggest you take medicines before you get an infection. This is to try to prevent it from happening. These are called prophylactic medicines. Prophylactic (pronounced prof-il-ak-tik) means preventative.

You might have medicines to prevent bacterial, viral or fungal infections.

Vaccines

Vaccines are a way of protecting you against certain infections. Your doctor is likely to suggest that you have:

• a yearly flu vaccine
• a vaccine to prevent pneumonia
• a coronavirus vaccine
• the shingles vaccine if you are over 50 years old

There are two main types of vaccines. These are live vaccines and inactivated (not live) vaccines.

You shouldn't have live vaccines if you have CLL. This is because live vaccines contain a very weak version of the illness. Your doctor can tell you which vaccines are safe, and which ones to avoid.

Growth factors to increase your white blood cells

Your doctor might suggest you have growth factors. Growth factors increases the number of white blood cells and stem cells in the blood. You usually have a growth factor called G-CSF (granulocyte-colony stimulating factor).

You might have a low number of white blood cells because of your CLL or the treatment. This means you are at an increased risk of getting an infection.  Having a growth factor helps your white cell count go up more quickly. This could lower the risk of infection.

You usually have growth factors as an injection under the skin. This might be in the tummy (abdomen), or into an arm or a leg.

Antibody treatment (immunoglobulins)

You might have a low level of antibodies in your blood. These antibodies are called immunoglobulins. Immunoglobulins fight infection.

You are more likely to get infections if you have low levels of immunoglobulin. You might need immunoglobulin treatment if you keep getting infections after you have tried long term antibiotics..

You usually have immunoglobulins:

• as a drip into your vein (intravenous) every 3 to 4 weeks
• as an injection under your skin (subcutaneous) every week

You might be able to give your own immunoglobulin injections. This depends on your individual circumstances and where you have treatment. Your healthcare team will let you know if this is a possibility for you.

Blood products

You might need to have a blood transfusion or platelet transfusion. This is because your bone marrow might not make enough red blood cells or platelets. This is a common problem caused by CLL and its treatment.

You should only have irradiated blood products following treatment with the chemotherapy drugs fludarabine or bendamustine. The radiation kills any white cells in the blood products. This protects you from a rare reaction to the blood cells. You should carry a card or wear a bracelet to make doctors and nurses aware of this. This is important in case of an emergency.

Blood transfusion

A low red blood cell count is called anaemia. You can feel very tired and have little or no energy. You might also feel breathless when you move around. Your doctor will check your blood counts. 

You can have a blood transfusion if you are anaemic. This can help you to feel better.

Some people have a reaction to the blood, although this is rare. Tell your doctor or nurse if you feel hot or cold and shivery during the infusion. Your nurse will give you medicines to reduce the reaction.

Platelet transfusion

You might have low platelet levels. Platelets help the blood to clot. A low platelet level means you are at risk of bleeding. Tell your nurse or doctor straight away if you have any signs of unusual bleeding, such as:

• blood in your urine or when you have your bowels open
• bruises or tiny red spots on your skin
• nosebleeds

You might need a platelet transfusion. 

Some people have a reaction to the platelets. This can make you feel hot or very cold and shivery when you are having the transfusion. Tell your doctor or nurse if you have this. They will give you medicines to reduce the reaction.

Treatment for autoimmune disorders

CLL can cause your immune system to attack your red blood cells or platelets. This is called an autoimmune disorder. You might develop:

• autoimmune haemolytic anaemia (AIHA) - your immune system attacks red blood cells
• immune thrombocytopenic purpura (ITP) – your immune system attacks platelets

AIHA causes the level of red blood cells in your blood to suddenly drop. You can feel very tired. You might also become breathless. This is because the amount of oxygen carried around your body is lower.

ITP cause the level of platelets in your blood to suddenly drop. Platelets help to clot the blood to prevent bleeding.

If the number of platelets in your blood is low, you might:

• bruise easily
• bleed more than usual, even from small cuts or grazes
• have nosebleeds
• have a rash of small purple or red dots

The rash is called purpura and is caused by bleeding within the skin.

You usually need treatment for AIHA and ITP. You might have one of the following treatments:

Steroids

You might take a course of steroids. You take the steroids as tablets every day for several weeks. You gradually cut down the steroid dose towards the end of the treatment course. Your doctor will tell you more about this. 

Cancer treatment drugs

Your doctor might decide to treat your CLL if the steroid treatment doesn't work.

Surgery

Rarely, your doctor might suggest surgery to remove your spleen . This operation is called a splenectomy. This can sometimes work well if other treatments do not work.

Pain or discomfort

CLL can cause pain or make you uncomfortable because:

• your spleen becomes swollen (enlarged)
• you have swollen lymph nodes
• leukaemia cells in the bone marrow are putting pressure on nerves, causing bone pain

Your specialist might suggest:

• surgery to remove your spleen to help with symptoms caused by an enlarged spleen
• radiotherapy to shrink your spleen or lymph nodes, or to help bone pain
• pain killers