Chemotherapy for chronic lymphocytic leukemia

Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. It may be used to treat chronic lymphocytic leukemia (CLL). Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is given for different reasons. You may have chemotherapy to:

  • destroy cancer cells in the body
  • return blood cell production to normal
  • control and maintain blood cell counts
  • shrink a spleen that is larger than normal, which may improve blood cell counts and relieve discomfort from the enlarged spleen pressing on other organs

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have spread to other parts of the body through the blood. The chemotherapy drugs used to treat CLL are given by a needle in a vein (intravenously) or by mouth.

Chemotherapy drugs used for CLL

The most common chemotherapy drugs used to treat CLL are:

  • fludarabine (Fludara)
  • bendamustine (Treanda)
  • cladribine (Leustatin)
  • chlorambucil (Leukeran)
  • cyclophosphamide (Cytoxan, Procytox)
  • pentostatin (deoxycoformycin, Nipent)
  • vincristine (Oncovin)
  • doxorubicin (Adriamycin)
  • mitoxantrone (Novantrone)

Other chemotherapy drugs that may be used to treat CLL include:

  • methotrexate
  • oxaliplatin (Eloxatin)
  • etoposide (Vepesid)
  • cytarabine (Cytosar, Ara-C)

A steroid such as prednisone or dexamethasone (Decadron, Dexasone) may be used in combination with chemotherapy. Targeted therapy such as rituximab (Rituxan) may also be included in the combination.

The most common chemotherapy combinations used to treat CLL are:

  • FCR – fludarabine, cyclophosphamide and rituximab
  • FR – fludarabine and rituximab
  • PCR – pentostatin, cyclophosphamide and rituximab
  • FCM – fludarabine, cyclophosphamide and mitoxantrone
  • CVP – cyclophosphamide, vincristine and prednisone
  • CHOP – cyclophosphamide, doxorubicin, vincristine and prednisone

If CLL responded well to a drug but then relapses, doctors may use the same drug again to try to return blood cell counts to normal. If CLL does not respond to the same drug again, doctors will give a different drug or combination of drugs.

If CLL becomes resistant to a drug, doctors will often try other types of drugs.

Side effects

Side effects can happen with any type of treatment for CLL but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug or drug combination, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for CLL are:

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Information about specific cancer drugs

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.

Questions to ask about chemotherapy

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.

Expert review and references

  • American Cancer Society. Leukemia - Chronic Lymphocytic. Atlanta, GA: American Cancer Society; 2013:
  • American Society of Clinical Oncology (ASCO). Leukemia - Chronic Lymphocytic - CLL: Treatment Options. Alexandria, VA.: American Society of Clinical Oncology (ASCO); 2014:
  • Borthakur G, O'Brien S . Treatment of chronic lymphocytic leukemia and related disorders. Wiernik PH, Goldman JM, Dutcher JP & Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 9: pp. 121-119.
  • Mir Muhammad A . Chronic lymphocytic leukemia treatment & management. WebMD LLC; 2014.
  • National Cancer Institute. Chronic lymphocytic leukemia Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.
  • Wierda WG, O'Brien S . Chronic lymphocytic leukemia. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014: 134: pp. 1973-1987.