NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

49 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 4 Treatment guide Supportive care Supportive care Guide 14. Supportive care by health condition Health condition Type of supportive care Severe ear, sinus, or lung infections • Medicine as needed • Test blood for antibodies ◦◦ If IgG <500 mg/dL, infusions of gamma globulin every month Flu • Influenza vaccine every year Pneumococcal infection • Vaccine every 5 years; Prevnar is preferred Blood transfusion needed • Transfusion should be done according to hospital standards • All blood products should be radiated Autoimmune hemolytic anemia • Diagnosis with reticulocyte and haptoglobin counts and direct antiglobulin test • If severe, stop taking fludarabine and do not take again • Treat with corticosteroids, IVIG, cyclosporin A, splenectomy, or rituximab Immune thrombocytopenic purpura • Diagnosis with bone marrow test for cause of low platelets • Treat with corticosteroids, rituximab, IVIG, cyclosporin A, splenectomy, eltrombopag, or romiplostim Pure red cell aplasia • Diagnosis with bone marrow test for cause of low platelets • Treat with corticosteroids, rituximab, IVIG, cyclosporin A, splenectomy, eltrombopag, or romiplostim Tumor lysis syndrome • If CLL is present in large amounts and you are at risk: ◦◦ Consider taking medicine to prevent Herpes virus • If receiving purine analogs, bendamustine-based chemotherapy, idelalisib, and/or alemtuzumab: ◦◦ Start taking medicine like acyclovir to prevent infection Pneumocystis pneumonia • If receiving purine analogs, bendamustine-based chemotherapy, idelalisib, and/or alemtuzumab: ◦◦ Start taking medicine like sulfamethoxazole and trimethoprim to prevent illness Cytomegalovirus reactivation • If receiving fludarabine-based chemotherapy, idelalisib, or alemtuzumab: ◦◦ Start taking ganciclovir if virus is present or rising ◦◦ Blood tests of virus are needed every 2–3 weeks

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