Chronic lymphocytic leukaemia (CLL) drugs and side effects
This page tells you about the chemotherapy drugs used to treat chronic lymphocytic leukaemia (CLL). There is information about
Chronic lymphocytic leukaemia drugs
The drugs most commonly used to treat CLL are a combination of fludarabine and cyclophosphamide, with a biological therapy called rituximab. The combination is called FCR. Other drugs include chlorambucil, bendamustine, and a drug combination called CHOP. Your doctor may also suggest that you have growth factor injections to help your white blood cell count increase more quickly.
Chemotherapy drugs all have different side effects. The effects also vary from person to person. The side effects that tend to happen with all chemotherapy drugs are
- Low blood cell counts, making you more likely to get infections, anaemia, and bleeding or bruising
- Possibility of harm to the developing baby if you get pregnant or father a child
Both fludarabine and chlorambucil can also cause sickness, but this is usually mild. CHOP chemotherapy increases your risk of infection as well as causing sickness and hair loss. Other common side effects of CHOP include constipation, mouth ulcers and skin problems.
There are detailed pages about the specific side effects of these drugs in the main chemotherapy section.
You can view and print the quick guides for all the pages in the Treating CLL section.
Chemotherapy is usually given in a cycle. You have the drugs over a few days or weeks. Then you have a break of a few weeks to allow your body to recover from the effects of the chemotherapy. You repeat the cycle until you have had a full course of treatment. The number of cycles you have depends on
- Which drugs you are having
- How your CLL is responding to treatment
- How your body is coping with the side effects
There are many different chemotherapy drugs and they all have different side effects. Each drug will cause more side effects for some people than others. So no one can tell you exactly what will happen to you. The side effects that tend to happen with all chemotherapy drugs are
- A drop in your blood cell counts, making you more likely to get infections, anaemia and bleeding or bruising
- Possibility of harm to a developing baby
All the drugs will lower your levels of blood cells. This includes the red cells and platelets, as well as the white cells.
You are likely to feel tired while you are having chemotherapy and for a while after the treatment ends.
You should not become pregnant or father a child while on chemotherapy because many of the drugs can damage a developing baby. If there is any possibility that you could become pregnant or father a child it is very important to use effective contraception during your chemotherapy course and for a few months afterwards.
Doctors do not think that your chemotherapy treatment will affect your partner. But there is a small chance that the drug could find its way into your body fluids. Doctors don't know for sure, so they advise using barrier contraception (condom) during a course of chemotherapy and for a week or so afterwards. This applies whether it is the man or the woman being treated.
We have detailed information about how chemotherapy can affect the blood cells.
The most commonly used chemotherapy drugs for CLL are
- Fludarabine and cyclophosphamide with the monoclonal antibody rituximab, called FCR
- A combination of chemotherapy drugs called CHOP– cyclophosphamide, vincristine, doxorubicin and prednisolone (a steroid)
- Bendamustine, cladribine or pentostatin if you cannot have fludarabine
Fludarabine and chlorambucil have similar side effects, but they are generally milder with chlorambucil. Both drugs will lower your blood counts. But you are more likely to get infections with fludarabine than with chlorambucil. Both drugs can cause sickness but this is usually mild. If you do get sickness tell your doctor or nurse. They can prescribe anti sickness medicines.
Fludarabine and cyclophosphamide together cause more side effects than treatment with a single drug. You will have an increased risk of infection through your course of treatment. You may feel or be sick. And you could have some hair loss or thinning.
CHOP is sometimes used for CLL. It is a combination of 3 chemotherapy drugs, together with a steroid (prednisolone). The 3 drugs are cyclophosphamide, doxorubicin (Adriamycin) and vincristine. You will have an increased risk of infection and will need anti sickness medicine to keep sickness under control. Your hair may fall out completely. Other common side effects include constipation, mouth ulcers and skin problems. Let your doctor or clinical nurse specialist know if you get any of these effects, as there are ways of reducing or controlling them.
The section about cancer drugs has information about coping with side effects that you may find helpful.
As well as killing the CLL cells, the chemotherapy treatment affects your healthy white blood cells. This means you are at risk of infection while your white cell count is low. If you do get an infection your body is not able to fight it off as well as usual. So infections can make you more ill than they normally would and can even be life threatening.
If your white blood cell count gets very low (neutropenia) your doctor may suggest that you have injections of G-CSF (granulocyte stimulating factor). G-CSF is a growth factor drug that helps to increase your white blood cell count more quickly. In CLL, doctors generally only use this drug after combination chemotherapy, such as CHOP. Commonly used types of G-CSF include filgrastim and lenograstim.
Some doctors prefer not to give growth factors. Early research into their routine use has shown that growth factors may help the white cell count to recover. But they don’t seem to make much difference to the number of infections you are likely to get overall. They also don't make much difference to the number of courses of antibiotics you might need. But they can be useful for bringing up your white cell count so that your next chemotherapy cycle doesn't have to be delayed because your blood counts are too low to have it.
Having growth factor injections
You have G-CSF as an injection just under the skin. These will usually be in your tummy (abdomen), or into an arm or a leg. You usually have injections once a day, for several days at a time. The injections are not difficult to do. If you don't need to be in hospital, you can learn to give them yourself at home. Or someone in your family may be able to give the injections to you. A district nurse can also come into your home to give them.
Side effects of growth factors
Growth factor injections may have some side effects. Some people have itching around the injection site. You may have some aching in your bones after you have had a few injections. This is because the drug triggers a lot of blood cells to be made inside the bones. The aching is usually easy to control with a mild painkiller, such as paracetamol. Any pain you may have will go away on its own after a day or so.
Specialists sometimes use other drugs to treat CLL. These drugs are not chemotherapy. Doctors generally suggest these treatments if you have had chemotherapy before and it is no longer controlling your CLL. You may have
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