NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

26 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2019 3  Treatment guide Transformed CLL Transformed CLL For a few people, CLL changes into a faster-growing cancer. This is called Richter’s transformation. CLL may change into DLBCL ( d iffuse l arge B - c ell l ymphoma) or Hodgkin lymphoma. Lymphoma is a cancer of white blood cells within the lymph system. Transformed CLL needs to be confirmed with testing. A biopsy is needed. The tissue samples will be assessed for surface proteins. Blood tests and imaging will be done, too. DLBCL Treatment options depend on if the transformed cells are like CLL cells. If the cells are not alike, read NCCN Guidelines for Patients ® : Diffuse Large B-Cell Lymphoma for options. For DLBCL that has CLL features, a clinical trial is preferred. Another option is chemoimmunotherapy with RCHOP, R-DA-EPOCH, R-hyper-CVAD, or OFAR. If chemotherapy works, an allogeneic stem cell transplant may be an option if you are healthy enough. If chemotherapy doesn’t work, there are two options. You may receive treatments listed in NCCN Guidelines for Patients ® : Diffuse Large B-Cell Lymphoma . The other option is a PD-1 inhibitor with or without ibrutinib, but this treatment needs more research. Hodgkin lymphoma A clinical trial is preferred. For other options, read NCCN Guidelines for Patients ® : Hodgkin Lymphoma . Supportive care Supportive care is an important part of your cancer care. It can address many needs. It can prevent or relieve emotional or physical symptoms. It can also help with making treatment decisions. Supportive care also includes help with coordination of care between health providers. Guide 5 lists some of the supportive needs of people with CLL. Some apply to all people with CLL. Other needs are linked to specific cancer treatments. Talk with your treatment team to get the best supportive care plan for you. All cancer treatments can cause unwanted health issues. Such health issues are called side effects. Ask your treatment team for a complete list of side effects of your treatments. Also, tell your treatment team about any new or worse symptoms you get. There may be ways to help you feel better. Sometimes, a treatment may be stopped until you are better. Infections You are more likely to get infections due to CLL or its treatment. Get a flu shot every year and a pneumococcal vaccine every five years. But, don’t get a live virus vaccine. If you get frequent infections in your ear, sinuses, or lungs, you may get infusions of immunoglobulin to help prevent new infections. Cancer It is important to get screened for other cancers if needed. You may get screened for prostate cancer (men), breast and cervical cancer (women), and colon cancer. People with CLL are also at risk for skin cancer, the non-melanoma type. See a dermatologist once a year. Autoimmune cytopenia Autoimmune cytopenia is a condition in which your immune system attacks your blood cells. The

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