What are supportive treatments?

Supportive treatments, sometimes called supportive therapies, help control any symptoms caused by chronic lymphocytic leukaemia (CLL) or its treatment. This section explains the more common problems that some people with CLL have, and the treatments that can help.

Infections and chronic lymphocytic leukaemia (CLL)

People with CLL are more at risk of getting infections. This is because both CLL and the treatments used affect the immune system. You can usually be treated for infections as an outpatient. But some infections can be life-threatening. If you get one of these, you will need to stay in hospital for treatment. It is important to contact your doctor or specialist nurse straight away for advice if you develop:

  • a cough
  • a sore throat
  • a fever any other sign of infection.
See also

Shingles and chronic lymphocytic leukaemia (CLL)

People with CLL are at a higher risk of developing an infection called shingles. This is an infection of a nerve and the area of skin around it. It is caused by the same virus that causes chickenpox. Anyone who has had chickenpox may develop shingles.

The virus usually affects one nerve in one area of the body. The most common areas to be affected are one side of the chest, or one side of the tummy (abdomen). A nerve in the face can also be affected, but this is less common.

Symptoms of shingles

The first symptom is often a tingling or burning feeling in the affected area. This is followed by pain and a red rash. This develops 2 to 3 days later.

Contact your GP or the hospital immediately if you:

  • think you have shingles
  • come into contact with someone who has shingles or chickenpox.

Effective treatment can prevent or limit the infection. Shingles usually gets better within 2 to 5 weeks.

Vaccine against shingles

People over 70 are routinely offered a vaccine against shingles. But if you have CLL, this vaccine is not suitable for you because it is a live vaccine (see below). Your haematologist can give you more information about this.

Vaccines and chronic lymphocytic leukaemia (CLL)

Most people with CLL are advised to have a yearly flu vaccine. This is to give them as much protection as possible. Your doctors may also recommend two specific vaccines when you are first diagnosed. These are to protect against:

  • pneumonia
  • a type of infection called streptococcus.

Live vaccines

There are some types of vaccine that you should avoid. These are called live vaccines, because they contain the live virus in a weakened form. People with CLL have a weakened immune system, so a live vaccine may cause them harm. Your haematologist can tell you which vaccines are safe and if there are any you should avoid.

Low levels of antibodies and chronic lymphocytic leukaemia (CLL)

Many people with CLL have very low levels of infection-fighting antibodies (immunoglobulins) in their blood. This may mean they keep getting infections. Some people who are affected may need regular immunoglobulin treatment. A nurse gives the immunoglobulins:

  • as a drip (infusion) into a vein
  • as an injection under the skin.

Most people feel fine when they are having an immunoglobulin infusion, but sometimes it can cause a reaction. This can feel similar to the reaction a monoclonal antibody infusion may cause. A reaction is more likely with the first infusion, so it is given more slowly.

Auto immune reactions in CLL

CLL can sometimes cause the immune system to act against normal, healthy red blood cells or platelets.

Auto-immune haemolytic anaemia (AIHA)

If red blood cells are affected, this is called auto-immune haemolytic anaemia (AIHA). If you have AIHA, the number of red blood cells in the blood can fall very quickly. This can cause:

If you suddenly become very tired or breathless, contact the hospital straight away. You may need to have a blood test, and possibly treatment.

Immune thrombocytopenic purpura (ITP)

If platelets are affected, this is called immune thrombocytopenic purpura (ITP). With ITP, the number of platelets in the blood can fall suddenly. This can cause:

  • bruising
  • areas of tiny, dark, purple-red dots on the shins or arms
  • unusual bleeding from the gums
  • a nosebleed that takes a long time to stop.

If you have any of these symptoms, contact the hospital straight away for advice.

Transfusions and chronic lymphocytic leukaemia (CLL)

If your bone marrow is not making enough red blood cells or platelets, you may need to have a blood transfusion or platelet transfusion. You can have this as an outpatient.

If you are treated with fludarabine or bendamustine, you should only be given blood and platelet transfusions that have been treated with radiation (irradiated).

Irradiated transfusions should always be used during and after you have finished your treatment. This lowers the risk of the donated blood cells reacting against your own blood cells. Your hospital team should give you a card to carry or a MedicAlert ID tag to wear. This is so hospital staff are aware of this if you ever need a blood transfusion in an emergency.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Helen Marr, Consultant Haematologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.