What causes persistent fever after chemotherapy for CLL?

Question

Hello doctor,

I would like to enquire about my dad's health. He is 82 years old and has been having chronic lymphocytic leukemia for the past seven years. He had no symptoms other than the high blood cell count and was doing regular checkups every six months. Recently, his hemoglobin level dropped a lot (around 3 to 4 g/dL), white blood cell count was very high, he also had a high percentage of antibodies in his blood. I was also told the red cells were being destroyed. He was admitted to the hospital and was given Mabthera, after which he got better and went back home. His oncologist prescribed him a chemotherapy treatment of Mabtehra and something else. After the first chemotherapy session, he got a fever spell that has been persisting till today. It has been two weeks, and he still has a high fever, around 102.2 to 104 degrees Fahrenheit once every 24 hours.

He was admitted to the hospital the day he had the first fever peak and all tests have been run to try to identify an infection or a cause for the fever. He underwent blood tests, X-rays, scans, hemoculture, etc. Nothing seems to show what the reason for the fever is. We were told it could be a symptom of the CLL itself. What do you think? I would like to seek a second opinion.

Thanks in advance.

Answer 1

Hi,

Welcome to the icliniq.com.

You have mentioned in the history that the patient is having chronic lymphocytic leukemia. And the total count is high, as per history. So, chronic lymphocytic leukemia seems to be in the aggressive stage.
Blood culture and other scan reports are normal as per history. Yes, there might be an infection, which can lead to fever. In such a case, the blood culture might be positive, as the organism circulates through blood in septicemia like condition.
Secondly, a fever with night sweat can also be from the leukemic process itself, by the release of pyrogenic inflammatory mediators.
Your father was given Rituximab monoclonal antibody for CLL. He needs to be given a combination chemotherapy for CLL. Fludarabine is used as the first line treatment.
Stem cell transplantation is another mode of treatment for CLL. His CRP (C-reactive protein) can be monitored regularly to check for inflammatory process, as CRP reflects the degree of infection or inflammation.
So, regularly consult a nearby oncologist for starting chemotherapy and regularly get CBC (complete blood count) done.