8 Ways to Manage Side Effects of Chronic Lymphocytic Leukemia (CLL) Treatment

Chronic lymphocytic leukemia (CLL) is a common type of leukemia in adults. It affects the lymphocytes, a type of white blood cell that helps your blood circulate and fight infection.

Your doctor may recommend different treatments for CLL depending on your unique situation.

These treatments may include chemotherapy, radiation therapy, or other targeted procedures and immunotherapies. Bone marrow transplants, blood transfusions, and spleen removal surgery may also be options.

All these treatments bring their own sets of risks and side effects.

The most common side effects of CLL treatment are:

• fatigue
• infections
• nausea and vomiting
• diarrhea
• hair loss
• changes in taste or smell
• loss of appetite
• constipation
• body aches
• rash
• mouth sores
• lower blood cell counts, which can cause easy bleeding and bruising
• fever and chills
• reactions at the infusion site

Side effects can happen with any of the treatments for CLL, but everyone’s experience will be different.

Along with the tips below, your healthcare team can help you proactively manage the side effects of your treatment.

One of the most serious side effects of treatment is damage to the body’s immune system.

Your doctor will monitor your blood cell counts often as you receive chemotherapy. It’s crucial that you take proper care of yourself to minimize your chances of getting an infection from viruses, bacteria, fungi, or parasites.

Here are some steps you can take:

• Wash your hands frequently and thoroughly with soap and water after using the bathroom and being in public places.
• Avoid being around children and crowds of people.
• Avoid using rectal thermometers, suppositories, and enemas, as they may injure the rectal area and allow harmful bacteria to enter the body.
• Cook all meats thoroughly and to the proper recommended temperature.
• Wash all fresh fruits and vegetables well before consuming.
• Talk with your doctor about getting vaccinations before treatment starts.
• Wear a mask that covers your mouth and nose when in a public place.
• Wash all cuts and scrapes right away with warm water and soap.

Exercise can help relieve fatigue, nausea, and constipation. It can also improve your appetite and overall mood. A little bit of light exercise can go a long way.

Some exercise ideas to consider include:

• yoga
• qigong meditation
• walking
• swimming
• light aerobic or strength-training routines

You can ask your healthcare team for a referral to a physical therapist or fitness instructor who knows about fitness programs for people with cancer.

Local cancer support groups may also be able to help you find a fitness group.

Always consult your doctor before starting an exercise program.

Low platelets are another concern with CLL treatments. Platelets are needed to form blood clots, so low platelet levels can result in easy bruising and bleeding.

Take steps to protect yourself from injury by following these tips:

• Brush your teeth with an extra-soft toothbrush.
• Use an electric shaver instead of a razor.
• Avoid walking barefoot.
• Avoid using aspirin or other medications that can cause bleeding problems.
• Avoid contact sports or other activities with a high risk of injury.
• Don’t drink alcohol without your doctor’s approval.
• Take care not to burn yourself when ironing or cooking.

Chemotherapy often affects the digestive system. Nausea and vomiting are common side effects, though some people experience constipation and diarrhea as well.

Medications can manage digestive system side effects. They include:

• antiemetics
• antidiarrheal medications
• medications for constipation

At times, treatments can be physically exhausting. But sleeping can be difficult due to stress and anxiety.

These suggestions may help improve your sleep quality and reduce fatigue:

• Wind down before bedtime by taking a warm bath and listening to calming music.
• Go to bed at the same time every night.
• Keep your bedroom cool, quiet, and dark.
• Invest in a comfortable mattress and bedding.
• Avoid caffeine and alcohol before bedtime.
• Use stress-relieving techniques, like guided imagery, meditation, deep breathing, and muscle relaxation exercises, before bedtime.
• Avoid cellphone and computer screens before bed.
• Avoid napping during the day. If you need to nap, try to limit naps to 30 minutes.

Many cancer treatments cause loss of appetite, nausea, vomiting, and inability to absorb nutrients. This can sometimes lead to malnutrition.

Due to low red blood cell counts, eating enough iron is vital. Try to prioritize foods high in iron, such as:

• green leafy vegetables
• shellfish
• legumes
• dark chocolate
• quinoa
• red meat

You can help iron absorption by also eating a source of vitamin C, like citrus fruit.

If possible, talk with a nutritionist or dietitian to create a diet plan that ensures you get enough calories, fluids, protein, and nutrients.

Be sure to drink plenty of water, too. Dehydration can worsen fatigue.

Talk with your doctor about what signs and symptoms warrant an appointment and what is considered an emergency. A fever, chills, or signs of infection, like redness and pain, can be serious.

Write down the number of your doctor’s office and place it somewhere that can be easily accessed, like a refrigerator, and program it into your cellphone contacts.

Ask family or friends for help with difficult tasks. Loved ones often want to help but may not know what they can do for you. Give them a specific task to do around your house. This could include mowing the lawn, cleaning the house, or running errands.

Support groups can give you a chance to discuss your side effects with other people with CLL who are going through a similar experience.

You can contact your local Leukemia & Lymphoma Society chapter for a referral to a local support group.

As you begin treatment, it’s important that you communicate what you’re feeling to your healthcare team. This will help them tailor your therapy and improve your overall quality of life.

Ask your hematologist or oncologist about possible side effects of your specific treatment regimen and how to manage them.