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What Happens During Chemotherapy for CLL

Chemotherapy is the use of drugs to kill cancer cells. It is a systemic therapy because the drugs travel throughout your body in your bloodstream, killing cancer cells. The goal of chemotherapy is to kill enough leukemia cells to put the disease into remission and keep it there. Remission is when the signs and symptoms of cancer--either partially or totally--respond to treatment. With chronic lymphocytic leukemia, remission does not necessarily mean the cancer is cured. Even if the cancer is very advanced and can't be controlled, chemotherapy may help ease symptoms caused by cancer. This can improve your quality of life.

For chronic lymphocytic leukemia (CLL), chemotherapy is usually the first line of treatment after watchful waiting. If you develop symptoms or have signs that the leukemia is progressing, your doctor will probably suggest that you undergo chemotherapy treatments.

Most people have chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. However, you may need to stay in the hospital during treatment. This will depend on the drugs you are given and your general health. You may receive these drugs in pill form, by injection or IV, or in more than one way.

You usually receive chemotherapy in cycles over a period of time. That means you may take the drugs more than once, interspersed by periods without them. Having chemotherapy in cycles helps in many ways. It allows the drugs to kill more cancer cells because cells aren't all dividing at the same time. It allows your body to rest from the treatment, which also damages normal quickly dividing cells, such as mucous membranes and bone marrow cells. It also gives you an emotional break between treatments.

You may receive one drug at a time or a combination of drugs. Which drugs you get, as well as how often you receive them, will depend on many factors. These factors include your general health, the stage and subtype of your illness, and your doctor's familiarity with certain protocols. Here are some of the drugs that are used more commonly with CLL:

  • Fludara (fludarabine)

  • 2-CdA or Leustatin (cladribine)

  • Nipent (pentostatin)

  • Leukeran (chlorambucil)

  • Cytoxan or Neosar (cyclophosphamide)

  • Adriamycin or Rubex (doxorubicin)

  • Oncovin or Vincasar (vincristine)

  • Treanda (bendamustine)

Fludarabine seems to be the most effective drug used as a first line of treatment. If you're young, your doctor may try fludarabine, either as a single drug or along with Rituxan (rituximab), and/or other chemotherapy drugs. Other drugs that have similar effects as fludarabine include Nipent (pentostatin) and Leustatin (cladribine).

Your doctor may also prescribe steroids, such as prednisone. Prednisone helps combat a complication of CLL in which your immune system attacks your own red blood cells or platelets.

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