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Chemotherapy is the use of anti-cancer (cytotoxic) drugs, which work by destroying or damaging the leukaemia cells. The drugs circulate in the blood and can reach leukaemia cells all over the body.
Most people with CLL are first treated with chemotherapy tablets: this is known as oral chemotherapy. Chlorambucil is often the first treatment used. Another drug which may be used is fludarabine.
Chlorambucil tablets can be prescribed in different ways, depending on your needs. They are usually taken for about seven days each month. The dose may be changed according to the results of the blood tests you have before each course of treatment. Fludarabine tablets are usually taken for five days every month.
Some people need to have treatment given by injection into a vein (intravenous chemotherapy). You may have either a single chemotherapy drug, or a combination of two or more different chemotherapy drugs.
Intravenous chemotherapy is usually given for a few days once a month. This will generally be done in the outpatients department, depending on the drugs you are having.
Fludarabine by injection is commonly used for CLL. Cladribine or cyclophosphamide may also be used. High-dose dexamethasone (a steroid) may be used for some people.
The following are some combination chemotherapies that may be used:
Chemotherapy tablets usually have few side effects, but chlorambucil or fludarabine can make you feel sick (nauseated). Less commonly, chlorambucil can cause a skin rash.
Intravenous chemotherapy usually causes more side effects than chemotherapy tablets. The side effects will vary depending on the particular drugs that are used.
One of the most commonly used drugs, fludarabine, usually has some side effects. You may have a high temperature, chills and pain in your joints while it is being given, but this does not usually last long. You may be given medicines to try to prevent viral and fungal infections while you are taking fludarabine.
Chemotherapy will destroy the leukaemic white blood cells, but it also reduces the production of healthy white blood cells.
Sometimes, the level of normal white blood cells can become very low, making you more likely to get an infection. Your blood cell levels will be checked regularly while you are having treatment to make sure they are within a normal range. If your white cell count is too low, your treatment may be delayed for a while to allow your normal white cells to recover.
As you are less able to fight infection, you should contact your doctor or the hospital straight away if:
You may need to go into hospital to have antibiotics by injection. If the antibody levels in the blood are very low, a drip of antibodies (immunoglobulins) may be given.
Chest infections Some people with CLL may be given antibiotics to help prevent chest infections. Fludarabine, in particular, can make you more prone to chest infections. You may need to take antibiotics for up to a year.
Shingles People with CLL can be more likely to develop shingles. This is a viral infection, which causes a painful red skin rash made up of little blisters. It usually affects the skin over the chest but can involve any area of the body. In people who have low immunity, the shingles can spread to other parts of the body, which can be very serious.
Even if you have had shingles or chicken pox (which is caused by the same virus) in the past, it can come back in people with CLL. If you think you have shingles, or have come into contact with someone with shingles or chicken pox, it is important to contact your GP or the hospital immediately. Effective treatment is available to prevent or limit the shingles attack.
Chemotherapy can also lower the numbers of red blood cells and platelets.
Your red cell and platelet counts may take a while to recover and, from time to time, you may need a blood transfusion to boost your red cells, or a platelet transfusion. These can both be done in the outpatients department.
If you have a lot of transfusions over a long time, the antibodies in your blood may cause an allergic reaction to the blood or platelets. A reaction causes a high temperature and shivering. To stop this happening, you will be given an injection of steroids and antihistamine before each transfusion.
If you are having treatment with fludarabine or cladribine, any blood transfusions that you are given should be irradiated first, to prevent a reaction. You will be given a card to carry to remind the hospital staff that you should only be given irradiated blood.
Some of the injected drugs can make you feel or be sick (nausea or vomiting). If you do feel sick, let your doctor know. There are a number of different anti-sickness drugs available to reduce or stop nausea.
Some chemotherapy drugs can make your mouth sore and cause small ulcers. Regular mouthwashes are important and your nurse will show you how to use these properly. If you don't feel like eating during your treatment, you could try replacing some meals with nutritious drinks or a soft diet.
Fludarabine and chlorambucil do not normally make your hair fall out completely, although you may have some hair thinning. Whether or not you lose any hair depends on the exact type of drugs you are having. It is more likely with some of the other intravenous drugs that may be used. It is best to ask your doctor or chemotherapy nurse what to expect.
Chemotherapy affects people in different ways. Most people find they are able to lead a fairly normal life during treatment. If you are having chemotherapy over a long period of time however, you will probably have some tiredness and may have to take things much more slowly. For some people, tiredness can continue even when they are not having treatment. It is important to try to pace yourself and not do too much. If there are activities you cannot avoid, plan to build some rest periods into your day.
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