Complications in the treatment of CLL with purine analogues

The main complications from treatment of CLL with purine analogues are bone marrow depression resulting in cytopenia, immune suppression leading to infections, particularly opportunistic infections, and immune deregulation with autoimmune hemolytic anemia as the most common feature. These complications usually delay or even prevent further treatment, thus leading to a reduced clinical response. In order to achieve the greatest benefit from purine analogue therapy, it is important to be able to predict the risk of such complications, and to use a treatment strategy with optimal dose intensity, by prophylactic supportive care when required, and by early detection and adequate management of complications.