Patients with CLL are more likely to develop second malignancies. Supportive care includes transfusion of packed RBCs for anemia, platelet transfusions for bleeding associated with thrombocytopenia, and antimicrobials for bacterial, fungal, or viral infections. Herpes zoster is common and usually dermatomic. Response to acyclovir and related antiviral drugs is usually satisfactory. Therapeutic infusions of -globulin should be considered in the patient with hypogammaglobulin and refractory infections or, for prophylaxis, when two or more severe infections occur within 6 mo.
Specific therapy includes chemotherapy, corticosteroids, and radiotherapy.
Treatment has not been proven to prolong survival. Overtreatment is more dangerous than undertreatment. However, fludarabine is more effective. Remissions are longer than with other treatments, although survival advantage has not been demonstrated. Patients with prolymphocytic leukemia and lymphoma leukemia usually require multidrug chemotherapy and often respond only partially.