NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia
32 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 3 Cancer treatments Stem cell transplant Rituximab Like obinutuzumab and ofatumumab, rituximab also attaches to CD20. It works by marking cells for destruction but it may directly kill the cells, too. It is sometimes used alone, with chemotherapy, or with another targeted therapy to treat CLL. Rituximab is a liquid that will be slowly injected into your vein. It often takes a few hours to receive the full dose. How often you will receive rituximab depends on what other cancer medicines you are receiving. You may have an allergic reaction while receiving rituximab. Other common side effects are chills, infections, body aches, tiredness, and low blood cell counts. Rituximab also increases your chances for tumor lysis syndrome, heart problems, and blockage and holes in your gut. Stem cell transplant Hematopoetic stem cells are cells that develop into mature blood cells. Stem cells and mature blood cells are made in bone marrow. The goal of a stem cell transplant is to cure cancer by replacing unhealthy blood stem cells with healthy ones that will attack cancer cells. This is done by suppressing the bone marrow and cancer with chemotherapy then transplanting healthy blood stem cells. The healthy blood stem cells will grow, form new marrow and blood cells, and attack remaining cancer cells. Using stem cells from a donor is called an allogeneic stem cell transplant. Besides a new immune system, another benefit of this transplant is the GVL ( g raft- v ersus- l eukemia) effect. The GVL effect is an attack on cancer cells by the transplanted stem cells. Allogeneic stem cell transplant is sometimes used to treat CLL. It is an option for some people after drug treatment has been received. The steps of treatment with allogeneic stem cell transplant are described next. HLA typing Special testing must be done to find the right donor for you. The donor and your tissue type must be a near-perfect match for this treatment to work. The test used to check tissue type is called HLA ( h uman l eukocyte a ntigen) typing. A blood sample is needed to perform the test. Conditioning chemotherapy Before the transplant, you will receive chemotherapy. The chemotherapy will suppress your immune system, allowing the donor cells to grow. The high- dose chemotherapy also destroys normal cells in the bone marrow. This greatly weakens your immune system so that your body doesn’t kill the transplanted stem cells. Not every person can tolerate the high- dose chemotherapy before the transplant. Side effects of chemotherapy are described earlier in this chapter. Transplanting stem cells After chemotherapy, you will receive the healthy stem cells through a transfusion. A transfusion is a slow injection of blood products through a central line into a large vein. A central line (or CVC, c entral v enous c atheter) is a thin tube. The tube will be inserted into your skin through one cut and into your vein through a second cut. Local anesthesia will be used. This process can take several hours to complete. The transplanted stem cells will travel to your bone marrow and grow. New, healthy blood cells will form. This is called engraftment. It usually takes about 2 to 4 weeks. Until then, you will have little or no immune defense. You may need to stay in a very clean room at the hospital. You may be given an antibiotic to prevent or treat infection. You may also be given a blood transfusion to prevent bleeding and to treat anemia. While waiting for the cells to engraft, you will likely feel tired and weak.