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About chemotherapy for chronic lymphocytic leukaemia (CLL)

Men and women discussing chronic lymphocytic leukaemia

This page tells you about chemotherapy for chronic lymphocytic leukaemia (CLL). There is information about

 

A quick guide to what's on this page

About chemotherapy for chronic lymphocytic leukaemia (CLL)

Chemotherapy is the main treatment for CLL. Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate in the bloodstream around your body. The most common chemotherapy treatments are

  • Fludarabine and cyclophosphamade with the monoclonal antibody, rituximab
  • Chlorambucil
  • Bendamustine

If your CLL comes back after a period of remission, your doctor may suggest treatment with the same drug again. But if the chemotherapy is no longer controlling the CLL your doctor will recommend a different drug or combination of drugs. 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating CLL section.

 

 

What chemotherapy is

Chemotherapy is the main treatment for chronic lymphocytic leukaemia. Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate around the body in the bloodstream.

 

Initial chemotherapy for CLL

The most common initial treatment (first line treatment) for CLL is chemotherapy. The type of chemotherapy you have will depend on the stage of the CLL and how well you are. The initial chemotherapy aims to put the leukaemia into remission. Remission means there is no sign of the leukaemia in your blood or on scans and you have no symptoms. 

The combination of fludarabine, cyclophosphamide and a biological therapy called rituximab (Mabthera) (FCR) is often the initial therapy. You have this combination of chemotherapy drugs as tablets and through a drip. FCR works well for CLL for people who are reasonably fit. So your doctor is most likely to suggest this if you are younger. They may also suggest it if you have had some test results that show your CLL may need more intensive treatment. But this combination may not suit people with CLL who also have other health issues. Whether this combination is suitable will also depend on other factors such as the stage of the disease and whether or not you have any CLL gene mutations

Another commonly used chemotherapy drug is called chlorambucil. You take it as a tablet at home and it has very few side effects. You usually take these tablets for 1 or 2 weeks out of every 4 weeks. Every 4 weeks counts as one cycle of treatment. You take the tablets for up to a year (12 cycles). How long you take this treatment depends on how well the treatment controls the CLL. You are more likely to have chlorambucil if you are older and less able to cope with the side effects of the FCR drug combination. 

Newer chemotherapy drugs that can be used instead of fludarabine are bendamustine, pentostatin or cladribine.  You may have bendamustine with the biological therapy called rituximab (Mabthera) in a regime called BR. Or you may have a reduced dose of pentostatin, cyclophosphamide and rituximab (PCR).

A bone marrow or stem cell transplant is still a very experimental treatment for CLL. In some situations, specialists may suggest a transplant to try to cure CLL or keep it under control for longer. If you have this type of treatment, you will have to go into hospital. You will have high dose chemotherapy through a drip. Because this treatment is quite intensive, you will have a high risk of picking up an infection afterwards. You will need to stay in hospital for a few weeks at least. We have a section about bone marrow and stem cell transplants.

There is more about the chemotherapy drugs used to treat CLL on the next page in this section.

 

Further treatment (second line)

If your CLL has come back after a period of remission following treatment with chlorambucil, your doctor may recommend chlorambucil tablets again. Chlorambucil can get the CLL back into remission for some people.

If you had chlorambucil as initial chemotherapy and the CLL didn't go into remission your doctor may recommend a combination chemotherapy called CHOP. CHOP is cyclophosphamide, doxorubicin, vincristine and prednisolone. 

Some people develop CLL that becomes resistant to chemotherapy. That means it stops responding to the treatment. Your doctor may then suggest treatment with high dose steroids or treatment with the biological therapies alemtuzumab or rituximab. Your doctor may also suggest these treatments if you have a lot of very enlarged lymph nodes.

Your doctor will decide how many sessions (cycles) of treatment you have, depending on how well the treatment works.

In particular circumstances, your specialist may decide that intensive treatment with a stem cell transplant of your own stem cells could help you. You have this treatment as part of a clinical trial. If people are younger than 50 and very fit, their doctor may recommend a donor transplant. Although a donor transplant may possibly cure the CLL, it causes a lot of severe side effects and so is not used very often.

 

Having chemotherapy

You have some chemotherapy drugs for CLL as tablets, for example, chlorambucil, fludarabine or cyclophosphamide. But some of the CLL treatments are given into a vein. You have these treatments in the outpatient department for a few days each month. Your doctor will ask you to have regular blood tests throughout your course of treatment. The tests check your white blood cell, red blood cell and platelet levels.

Chemotherapy tablets

If you are taking chemotherapy tablets at home, it is important that you take them correctly and store them safely. Follow the instructions from your pharmacist that come with the tablets. You must be particularly careful about storing your tablets if children live in your house, or visit you. The tablets should preferably be locked up, or at least kept somewhere where children can't get at them. Chemotherapy tablets are very dangerous if they are not prescribed for you. 

Chemotherapy into the bloodstream

For chemotherapy into your bloodstream, you usually go to the hospital or chemotherapy day unit and can go home the same day. Depending on the drug, you may have your chemo by injection through a small needle (cannula) into a vein over a few minutes. 

cannula

Some people have chemotherapy through a drip over a longer period. Before each treatment you will have a blood test to check your white blood cell, red blood cell and platelet counts.

With some drugs you have to stay in hospital overnight. This may be because the drug needs to be given very slowly. Or because you need to have fluids through your drip to flush the chemotherapy out of your system.

For more intensive high dose treatment, you will stay in hospital for longer. As you will need quite a few drugs, your doctor will arrange for you to have a central line put in. There is detailed information about all these types of central lines in the main chemotherapy section.

 

Dietary or herbal supplements and chemotherapy

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed any remedies by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in our complementary therapies section.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

 

Where to find out more about chemotherapy

The general section about chemotherapy explains the treatment in detail including

If you would like more information about anything to do with chemotherapy, contact our cancer information nurses. They will be happy to help.

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Updated: 17 July 2013