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When and how is chemo used to treat chronic lymphocytic leukemia (CLL)?

In the past, when people with CLL needed to be treated, chemo was usually part of the main treatment (often along with an immunotherapy drug, known as chemoimmunotherapy, or CIT). But as newer, more effective targeted drugs have become available, chemo is now used less often.

Chemo might be used (often along with an immunotherapy drug) if:

• It's important to get a quick response to treatment
• A person can't be treated with targeted drugs for some reason
• Other drug treatments have already been tried and are no longer helpful

Chemo is also often an important part of the treatment for people getting a stem cell transplant.

Doctors give chemo in cycles, with each treatment period followed by a rest period to allow the body time to recover. Chemo cycles generally last about 3 to 4 weeks. Because of the side effects it can cause (see below), chemo might not be recommended for people in poor health, but age by itself should not keep anyone from getting chemo.

Chemo drugs used for chronic lymphocytic leukemia (CLL)

The chemo drugs most often used to treat CLL include:

• Fludarabine
• Cyclophosphamide
• Bendamustine
• Chlorambucil
• Corticosteroids, such as prednisone, methylprednisolone, or dexamethasone

Chemo drugs might be combined and/or used with immunotherapy drugs. Examples of common regimens include:

• Fludarabine, cyclophosphamide, and rituximab (FCR)
• Bendamustine and rituximab (BR)

Possible side effects of chemo

Chemo drugs work by attacking cells that are dividing quickly, which can lead to side effects.

Chemo side effects depend on the type and dose of drugs given and the length of time they are taken. Common side effects include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting

Chemo can also cause low blood cell counts, which can lead to:

• Increased risk of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue and shortness of breath (from having too few red blood cells)

These side effects usually go away once treatment is finished. There are often ways to lessen or even prevent these side effects. For instance, drugs can help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects, and let them know when you do have side effects so they can be managed before they get worse.

Drugs known as growth factors, such as G-CSF (filgrastim), pegfilgrastim, and GM-CSF (sargramostim), might be given to increase white blood cell counts and help reduce the chance of infection (see Infections in People With Cancer).

Tumor lysis syndrome is another possible side effect of certain types of chemo. It's most common in people who had large numbers of leukemia cells in their body before treatment. (This may be called bulky disease.) It most often happens with the first cycle of chemo. When the CLL cells are killed, they break open and release their contents into the bloodstream. This can overwhelm the kidneys, which can't get rid of all of these substances at once. This can lead to build up of excess amounts of certain minerals in the blood and even kidney failure. The excess minerals can cause heart and nervous system problems. These problems might be prevented by giving the person extra fluids and certain drugs, such as sodium bicarbonate, allopurinol, febuxostat, and rasburicase.