CLL Treatment: Side Effect Profiles Vary
- Targeted therapies have transformed chronic lymphocytic leukemia (CLL) treatment, offering effective options that work differently from chemotherapy. These come with their own sets of side effects, but they can often be managed.
- Targeted therapies, BTK inhibitors, BCL‑2 inhibitors, and anti‑CD20 antibodies, each have different side effect profiles. Bruising and fatigue are possible with BTK inhibitors, while BCL‑2 inhibitors might require additional monitoring early on due to infection risk. Infusion-related reactions are possible with anti-CD20 antibodies.
- Side effects should never be silently tolerated — most can be managed by adjusting medications or using supportive treatments, with the goal of controlling CLL while maintaining your quality of life.
“When we look at [targeted therapy] BTK inhibitors, the common side effects are bleeding, bruising, and skin rash. That can be bothersome for patients, particularly when the bruising is quite extensive,” Dr. Kevin Kelly, a hematologist at the University of Southern California, tells SurvivorNet.
Read MoreSide Effect Profiles Vary
Possible side effects vary based on the type of targeted therapy a patient is getting for CLL. Understanding the general differences between these treatment categories can help you understand what to expect and when to contact your care team.There are three main types of targeted therapies commonly used in CLL:
- BTK inhibitors
- BCL-2 inhibitors
- Anti-CD20 antibodies
While side effects vary from person to person, each category has some common issues that your care team will watch for and help you manage.
“With CLL in general, I think the biggest issue patients face is more frequent infections,” Dr. Kelly explains.
“So we often have to supplement with intravenous immunoglobulin if patients are getting a lot of infections, and that can really improve quality of life by reducing the number of infections, hospitalizations for pneumonia, antibiotic courses for urinary tract infections, et cetera.”
Possible Side Effects From CLL Treatment
BTK inhibitors, such as ibrutinib, acalabrutinib, and zanubrutinib, are commonly used to treat CLL.
Possible side effects include:
- Bruising
- Diarrhea
- Muscle or joint aches
- Fatigue
- Headaches
Some people can also develop high blood pressure or heart rhythm problems.
Since BTK inhibitors can increase the risk of bleeding and infections, and may interact with other medications, it is important to let your care team know about new medicines, supplements, unusual bleeding, or heart-related symptoms.
Expert Resources for CLL Patients
- BTK Inhibitor Combination Therapy for CLL: Weighing the Benefits and Trade-Offs
- After the Initial CLL Diagnosis: The First Conversation
- BTK Inhibitors Play An Important Role In CLL Treatment & Management
- BTK Inhibitors: Finding The Right Fit For Chronic Lymphocytic Leukemia (CLL) Patients
- BTK Inhibitors for CLL Treatment: What Side Effects Can I Expect and How Do I Manage Them?
BCL-2 inhibitors, such as venetoclax, can be very effective but require careful monitoring, especially when treatment is first started.
Possible side effects linked to venetoclax include:
- Low blood counts
- Infections
- Tumor lysis syndrome (a rapid breakdown of leukemia cells that can affect the kidneys and other organs)
Your care team may gradually increase the dose and check your blood work during this period. After the initial treatment period, many people find venetoclax manageable.
Anti-CD20 antibodies, such as obinutuzumab and rituximab, are given by infusion and help the immune system target CLL cells.
The most common side effects from anti-CD20 antibodies occur during or shortly after an infusion and can include:
- Fever
- Chills
- Flushing
- Nausea
- Changes in blood pressure
Your care team will monitor you closely during treatment and may give medications beforehand to reduce the chance of a reaction.
“We need to remind patients that they need to hold the medication before any surgical procedures. With other side effects, particularly with the older generation of BTK inhibitors, we used to see a lot of GI side effects. Thankfully, that’s a lot less with the newer generation drugs,” Dr. Kelly explains
The important message is that side effects do not have to be something you simply tolerate. Tell your medical team about new or bothersome symptoms.
Many side effects can be treated or managed by adjusting the medication, changing the dose, or using supportive medicines. The goal is to control your CLL while helping you maintain the best quality of life possible.
Questions To Ask Your Doctor
- What is the best way to contact you if I am experiencing side effects?
- How will I be monitored during treatment?
- What happens if my cancer continues to progress?
- What are the next steps if my side effects become too much to manage?
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