What Causes Fatigue in CLL Patients and How Can It Be Treated?

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Topics include: Treatment and Understanding

Why do CLL patients experience fatigue? Dr. John Burke and Dr. William Wierda, renowned CLL experts, explain the potential causes of fatigue in CLL patients. The physicians discuss strategies for coping with this common symptom and available therapies to help combat fatigue.

This program was made possible by Pharmacyclics LLC and Janssen Biotech, Inc. Produced in partnership with Rocky Mountain Cancer Centers.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jeff Folloder:

Why do CLL patients experience fatigue? I’m going to start on one end, and we’re going right down the line, because I bet we have three different opinions.

Dr. Wierda:          

So there are cells in the immune system that have become abnormal. They’re B cells. B cells are normally in the immune system cells that make antibodies. In CLL, the B cell has become abnormal or malignant. As a cell of the immune system, it can make chemicals, proteins, chemical messengers in the body that can make you feel fatigued, and that’s probably the main reason why patients experience fatigue. It’s probably not unlike the fatigue individuals experience who have the flu, for example, because B cells become activated in individuals who have the flu. And those B cells and T cells are making cytokines, these chemical messengers that make you feel bad and make you feel fatigued.

So I think probably the main cause is that the leukemia cells and the leukemia cells making these chemical messengers that make you feel bad—give you fever, give you night sweats, all the big symptoms.

Jeff Folloder:     

What are your insights on the whole fatigue situation? And let’s try to be specific. We’re not talking about being tired, are we? We’re talking about your ability to conduct your life being extracted. 

Dr. Burke:            

The other thing I would add to what Dr. Wierda just said is anemia. If people have advanced enough CLL that’s causing their red blood cells to go low, that’s another factor that can cause fatigue. But I’ll just comment, it’s really tough for me. I’d like to hear Dr. Wierda’s comments on this. But I see patients who have CLL and absolutely no reason to treat other than fatigue. I just had this conversation with a patient yesterday. I don’t know if she’s in the room.             

There she is. And she said, I’ll summarize our conversation here. She said, “I’m getting more tired, and it’s affecting some of the things I do.” She’s still able to exercise and live her life, but she is getting more tired and more fatigued. She’s got kind of a gradual rise in her white counts—about 30,000—does not have anemia, does not have any other reason to be treated.            

And I want to help someone like that and make them feel better and be vigorous again. But I always wonder, can I do that? Because if I put someone like that on chemo, chemo makes you fatigued too, and it could certainly worsen the way she feels and not improve the way she feels. So for me that’s a tough situation, and I struggle with how to really help someone in that situation.            

Is it worth treating, or is it better off to just watch and wait? She may have another five or 10 years before she really needs treatment.

Jeff Folloder:     

And are there medications, are there treatments that you can offer a patient to deal with the fatigue short of starting CLL treatment?

Dr. Burke:            

Not to my knowledge. We talk about diet and exercise and eating healthy and living healthy, but people like her do that already and still feel fatigued.

Jeff Folloder:     

I know that some people will be prescribed a course of Adderall or something like that, and it appears to work for some and not for others. The concept of being prescribed an ADD drug to keep you awake is kind of counterintuitive. What’s going on with treating fatigue there?

Dr. Wierda:          

So the Adderall and Ritalin are stimulants, so they work as stimulants with patients with CLL, and as you say with some patients they will be effective in treating the fatigue.

They have the opposite affect for individuals who have ADHD where even though they’re a stimulant, they work particularly in those individuals to focus them, and they don’t act as a stimulant in those individuals. They have an opposite effect.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on July 21, 2017