Canterbury DHB

Context

Monitoring and Supportive Care

See below for dosage modifications, assessment of response, adverse effects, and supportive care needed.

In This Section

Dose Modifications

Adverse Effects

Supportive Measures

Monoclonal Antibodies in CLL

Dose Modifications

Neutropenia and thrombocytopenia may be due to the disease. However, if the fall in counts is due to treatment, the following guidelines should be followed for the next treatment course:

Neutrophils 0.5-1x109/L or platelets 50-75x109/L. Delay next treatment for 1 week.

If after 2 weeks' delay the values have not changed, treatment could proceed at 50% of the dose at the discretion of the specialist.

If neutrophils are below 0.5x109/L or platelets below 50x109/L by the time a new course is due, delay treatment until the counts rise to at least these levels, with dose modification at the discretion of the specialist.

Adverse Effects

Chlorambucil - Grade 3/4 neutropenia and thrombocytopenia is seen in around 15-20%. Gastro-intestinal effects are less common. Rare side effects are allergy, skin reactions and pulmonary toxicity.

Fludarabine - This drug is more myelosuppressive and immunosuppressive than chlorambucil and can also cause severe CD4 lymphopenia. It may be associated with infections, in particular pneumocystis pneumonia, and may precipitate autoimmune complications. Mucositis is rare. Myelosuppression with neutropenia, thrombocytopenia and lymphopenia may occur. Other possible side effects are fever, chills, nausea, emesis, malaise, fatigue, anorexia, weakness, hearing loss, numbness, pneumonia, cough, shortness of breath, diarrhoea, stomatitis, gastrointestinal bleeding, rashes, and rarely peripheral neuropathy.

Fludarabine plus cyclophosphamide - Nausea/vomiting; fatigue, infections, including pneumonia. This combination is more toxic than either drug given alone. In view of the increased risk of myelosuppression check blood counts should be done at 7 days and 14 days at least during the initial treatment course. Subsequent dose modification may be needed if severely cytopenic. G-CSF may need to be considered.

About this Canterbury DHB document (5513):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

September 2018

Next Review:

September 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5513