NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

50 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 4 Treatment guide Supportive care Guide 15. Supportive care by health condition Health condition Type of supportive care Hepatitis B • If receiving anti-CD20 monoclonal antibodies: ◦◦ Test to assess status ◦◦ Start taking medicine to prevent Hepatitis C (related to B-cell NHL) • If chronic (long-term) carrier of hepatitis C virus with genotype 1 (most common type of hepatitis C): ◦◦ Start taking medicine to prevent An increase in the size of organs with CLL after starting treatment (ie, tumor flare reactions) • If receiving lenalidomide: ◦◦ Consider preventing flare if large lymph nodes present ◦◦ Prevent with prednisone 20 mg for 5–7 days then reduce amount over 5–7 days ◦◦ If flare occurs, treat with prednisone 25–50 mg for 5–10 days ◦◦ Antihistamines for rash and itching, such as cetirizine 10 mg 4X a day or loratadine 10 mg 1X a day Blood clot • If receiving lenalidomide: ◦◦ Start taking aspirin 81 mg/day if high number of platelets unless already on warfarin Irregular, fast heart beat (ie, atrial fibrillation) • If receiving ibrutinib: ◦◦ Consider non-warfarin anticoagulation medicine ◦◦ If atrial fibrillation can’t be controlled, switch to idelalisib Serious bleeding • If receiving ibrutinib: ◦◦ Stop taking ibrutinib if on warfarin ◦◦ Weigh the pros and cons of ibrutinib if on antiplatelet or anticoagulant treatment ◦◦ Stop ibrutinib before surgery and delay re-starting afterward Liver damage (ie, hepatotoxicity) • If receiving idelalisib: ◦◦ Stop idelalisib until problem is solved Diarrhea or swollen colon (ie, colitis) • If receiving idelalisib: ◦◦ Stop idelalisib until problem is solved Holes in gut • If receiving idelalisib: ◦◦ Stop idelalisib if it is likely causing holes in your gut Inflammation of the lungs (ie, pneumonitis) • If receiving idelalisib: ◦◦ Stop idelalisib if symptoms appear

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