About chemotherapy
When and how you have chemotherapy for chronic lymphocytic leukaemia and the different types of drugs used.
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 treatment
The most common initial treatment (first line treatment) for CLL is chemotherapy. The type of chemotherapy you have depends on the stage of your CLL and how well you are.
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.
Initial therapy is often a combination of drugs called FCR. It is made up of:
- fludarabine
- cyclophosphamide
- a targeted cancer drug called rituximab (Mabthera)
You have this combination of drugs as tablets and through a drip.
FCR works well for people who are reasonably fit so it will most likely be suggested if you are younger. This combination may not suit people 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 chlorambucil. You take it as a tablet at home and it has fewer 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 and you take it for up to a year (12 cycles). How long you have treatment depends on how it 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
Newer chemotherapy drugs that can be used instead of fludarabine are:
- bendamustine
- pentostatin
- cladribine
You might have bendamustine with rituximab (Mabthera) in a regime called BR or chlorambucil with obinutuzumab.
Obinutuzumab is a type of targeted cancer drug.
Bone marrow or stem cell transplant
A bone marrow or stem cell transplant is still a very experimental treatment for CLL. 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.
Further treatment
If your CLL has come back after a period of remission following treatment with chlorambucil, your doctor may recommend the targeted cancer drug ibrutinib.
If you had chlorambucil as initial chemotherapy and you now have Richters transformation you may be offered CHOP chemotherapy. CHOP is:
- cyclophosphamide
- doxorubicin
- vincristine
- 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 a cancer drug called alemtuzumab or rituximab. Your doctor may also suggest these treatments if you have a lot of very enlarged lymph nodes.
Other treatments for CLL are idelalisib, alemtuzumab and venetoclax.
Having chemotherapy
You have some chemotherapy drugs for CLL as tablets, for example, chlorambucil, fludarabine or cyclophosphamide. Some of the CLL treatments are given into a vein.
You have regular blood tests throughout your course of treatment. The tests check your white blood cell, red blood cell and platelet levels.
Taking your tablets or capsules
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.
Chemotherapy into the bloodstream
When you have chemotherapy into your bloodstream you usually go to the hospital or a chemotherapy day unit. You can usually 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.
Some people have chemotherapy through a drip over a longer period. Before each treatment you 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. You may also need to have fluids through your drip to flush the chemotherapy out of your system.
For more intensive high dose treatment, you 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.
Dietary or herbal supplements
We don't know enough 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 are prescribed alternative or complementary remedies.
Talk to your specialist about any other tablets or medicines you take while you are having active treatment.
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.
