How to Manage the Side Effects of Chronic Lymphocytic Leukemia (CLL) Treatment

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Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in adults. It starts in the bone marrow in the cells that will become white blood cells. It takes time for leukemia cells to build up in the body, and some people live with this form of cancer for years with few or no symptoms. Once there are enough leukemia cells, however, they can spread to your lymph nodes, liver, and spleen. At that point, you will develop symptoms and require treatment.


CLL treatments you may experience

Treatment for CLL depends on your symptoms and other factors. In specific cases, doctors will recommend chemotherapy, radiation, surgery, a stem cell transplant, and/or targeted drugs that attack specific parts of the CLL cells. Some treatments come with the following side effects.



The American Society of Clinical Oncologists (ASCO) emphasizes the importance of understanding the underlying causes of fatigue when you’re in treatment for CLL. Sure, chemotherapy or other treatments may be partly to blame, but there are other possible contributors – pain, depression, insomnia, poor nutrition, anemia – that you and your doctor can address. Otherwise, you may want to try remedies for fatigue like gentle exercise, mindfulness, yoga, or acupuncture.


Greater risk of infection

Treatment may compromise your immune system so you’ll have to be diligent in avoiding bacteria and staying healthy. Get plenty of rest, eat healthy foods, avoid crowds and contact with people who are sick, and wash your hands often. Also, be careful of sharp objects, and stay away from raw and undercooked meat, shellfish, or eggs that may contain harmful bacteria.



Fortunately, there are lots of good anti-nausea medications available, including NK1 receptor antagonists, 5-HT3 receptor antagonists, dopaminergic antagonists, dexamethasone (a steroid), and olanzapine. The American Cancer Society (ACS) also notes that anti-anxiety medications, cannabanoids, and antacids may help relieve nausea. Your doctor can combine these medications to find the right solution for your symptoms. Other ways to manage nausea include relaxation and positive imagery.


Hair loss

Wearing a cold cap before, during, or after receiving IV chemotherapy can help prevent hair loss. The cold temperature narrows the scalp’s blood vessels so less of the drug reaches the hair follicles. Also, minoxidil, a topical medication, may help prevent hair thinning as a result of targeted and hormone therapy. Using gentle shampoo, washing infrequently, patting hair dry, using a soft hairbrush, not blow drying, and sleeping on a satin pillowcase can also help minimize hair loss.


Loss of appetite

Eat five to six small meals each day, and don't limit the amount of food. Track times when you’re hungry and plan to eat then. Eat high-calorie, high-protein snacks, and indulge in your favorite foods. Increase calories by adding butter, cheese, whipped cream, or peanut butter. Drink liquids between meals so they don’t fill you up at mealtime. Ask family members to prepare your favorite dinners and join you. Try taking a walk before eating to build up your appetite.



If you’re struggling with diarrhea, you may want to avoid caffeine, alcohol, dairy, fat, fiber, orange juice, prune juice, and spicy foods. Unless your doctor advises them, you should also avoid laxatives, stool softeners, and metoclopramide (often used to treat nausea). Try eating small, frequent amounts of mild foods like bananas, rice, applesauce, and toast. And don’t forget to drink lots of water and clear fluids to prevent dehydration.


Fever and chills

Keep track of your temperature and call your doctor if it goes over 100.5 degrees Fahrenheit, advises the ACS. Then be sure to drink plenty of liquids, get lots of sleep, use a cold compress on your forehead if you feel hot, and take Tylenol if you are directed to do so by your doctor.


Radiation and skin reactions

Radiation therapy is rarely used to treat CLL, but when it is, it can damage healthy skin cells, causing skin to peel, itch, and hurt. Corticosteroid skin creams such as mometasone (Elocon, Momexin) applied four hours before radiation therapy may help prevent damage. Tell your doctor if you have any open sores or moist patches of skin before you start radiation treatment.