NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

27 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2019 3  Treatment guide Supportive care most frequent of these among people with CLL are autoimmune hemolytic anemia, immune-mediated thrombocytopenia, and pure red blood cell aplasia. Treatment may consist of corticosteroids, rituximab, IVIG, cyclosporin A, splenectomy, eltrombopag, or romiplostim. Tumor lysis syndrome Tumor lysis syndrome occurs when the waste released by dead cells is not quickly cleared out of your body. This results in kidney damage and severe blood electrolyte disturbances. It can be life threatening. Strong cancer treatments can cause tumor lysis syndrome. Drink lots of water to help prevent it. There are also medicines you can take. Blood transfusion Some people being treated for CLL will need a blood transfusion. The transfusion should be done according to hospital standards. All blood should be treated with radiation before the transfusion. This will prevent the new blood from attacking your body. Guide 5. Supportive care Health condition Type of supportive care Flu • Influenza vaccine every year; avoid live vaccine Pneumococcal infection • Pneumococcal vaccine every 5 years Frequent, severe infections of ears, sinuses, or lungs • Antimicrobials (eg, antibiotics) • If IgG <500 mg/dL, infusions of immunoglobulin every month Cancer • Cancer screening as needed Autoimmune cytopenia • Treat with corticosteroids, rituximab, IVIG, cyclosporin A, splenectomy, eltrombopag, or romiplostim Tumor lysis syndrome • Prevent with hydration, managing hyperuriciemia, and taking allopurinol, febuxostat, or rasburicase Herpes • Prevent with a drug like acyclovir Pneumocystis pneumonia • Prevent with drugs like sulfamethoxazole and trimethoprim Cytomegalovirus reactivation • Take ganciclovir if virus is present or rising Hepatitis B reactivation • Prevent or treat with entecavir Tumor flare reaction • Prevent with steriods if lymph nodes are enlarged • Treat with steroids and antihistamines Blood clot • Treat with aspirin if not on an anticoagulant Blood transfusion needed • Transfusion should be done according to hospital standards • All blood products should be radiated

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