NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia
51 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 4 Treatment guide Supportive care Guides 14 and 15 list some of the supportive care needs of people with CLL. Supportive care doesn’t aim to treat cancer but aims to improve quality of life. It is also called palliative care. Supportive care can address many needs. It can address emotional and physical needs, such as relieving symptoms. It can also help with treatment decisions as you may have more than one option. Supportive care also includes help with coordination of care between health providers. Talk with your treatment team to plan the best supportive care for you. Supportive care is an important part of your cancer care, especially during active cancer treatment. You are more likely to get infections due to CLL or its treatment. Some people with CLL get severe ear, sinus, or lung (pneumonia) infections again and again. These infections may require going to the hospital or getting an injection of medicine rather than taking pills. If you get severe infections, testing your antibodies (IgG level) is advised. If your level of IgG is low (<500 mg/dL) and you have severe, recurrent infections, you could benefit by infusions of gamma globulin (IVIG) every month to raise your IgG level above 500 mg/dL. Some vaccines to prevent illness are advised. Get a flu shot every year and a pneumococcal vaccine every five years. Some vaccines consist of live viruses or bacteria. Do not take live vaccines including the vaccine for shingles or the flu. If you are unsure about a vaccine, ask your treatment team about it. Some people being treated for CLL will need a blood transfusion. It is very important that the transfusion is 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. Autoimmune cytopenias are health conditions in which your immune system becomes confused and reacts against your own blood cells. The most frequent of these among people with CLL are autoimmune hemolytic anemia, immune-mediated thrombocytopenia, and pure red blood cell aplasia. Diagnosis and treatment of these conditions are listed in Guide 14. Tumor lysis syndrome was described in Part 2. It can occur among people with large amounts of CLL who are undergoing strong cancer treatments. If you are at risk, think about starting medicine to prevent this illness. Other health conditions listed in Guide 15 are linked to specific cancer treatments. Read through the list to see if any apply to you. Purine analogs are a type of chemotherapy that includes fludarabine, cladribine, and pentostatin. Anti-CD20 monoclonal antibodies include obinutuzumab, ofatumumab, and rituximab. Risk for other cancers It is important to talk with your doctor about screening for other cancer. Regular screening for prostate cancer, breast cancer, cervical cancer, and colon cancer is important. People with CLL are also at risk for skin cancer, the non-melanoma type. Being white and having a large amount of contact with the sun at a young age are both risk factors. NCCN recommends you see a dermatologist, a doctor who specializes in skin cancer screening, once a year.