Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Cancer Care

Fremont and San Leandro Medical Centers


Chronic lymphocytic leukemia (CLL) is a slow-growing cancer that affects certain white blood cells (lymphocytes). It develops when the bone marrow makes too many cancerous white blood cells. 

When these cells grow in lymph nodes instead of blood or bone marrow, the condition is called small lymphocytic lymphoma (SLL). Treatment for CLL and SLL is the same.

For some people, CLL progresses so slowly that treatment may not be needed for a long time or at all. Others have a more aggressive form of CLL. It grows quickly and may require treatment sooner.

Treatment options for CLL include:

  • Watchful waiting
  • Targeted therapy
  • Chemotherapy, for some people
  • Immunotherapy
  • Radiation therapy, for some people
  • Stem cell transplant, for some people 

CLL is not usually curable. You may need periodic treatment to control CLL. 

We’ll regularly check your blood counts and possibly bone marrow to see how your CLL responds to treatment. This information helps us determine if we should:

  • Continue the same treatment.
  • Increase the dose of any medications.
  • Try another therapy that may be more effective.

Watchful Waiting

Because CLL grows so slowly, you may not need any treatment in the early stages of the cancer. This is called watchful waiting. 

You’ll have regular checkups so we can monitor your blood counts and physical health. If your blood counts worsen or you develop symptoms, you’ll begin treatment. 

Treatment is never needed in some people who live for years without symptoms.

It can be difficult to know that you have cancer but not receive treatment. We’ll talk together so you understand watchful waiting is the best approach for low-risk CLL. 

Treating CLL too early doesn’t offer any benefits. It can even cause unnecessary treatment side effects. 

Targeted Therapy

Targeted therapy drugs attack specific parts of a cancer cell that normally help it survive and grow. Because it targets cancer cells, there’s less damage to healthy cells. However, you may still have side effects, such as: 

  • Flu-like symptoms, including fever and chills
  • Fatigue and dizziness
  • Nausea and vomiting
  • Skin redness, dryness, and itching
  • Low blood cell counts

We’ll monitor you closely for side effects. Let us know as soon as you notice any symptoms.

These are some of the targeted therapy medications we might use to treat CLL.


This is the most commonly used drug. Side effects tend to be mild, although it’s important to avoid infections while taking it. 

Rituximab (Rituxan)

It’s an antibody that attacks leukemia cells. It’s often prescribed on its own or is combined with a traditional chemotherapy drug. 


You may have a few of the listed side effects while taking this drug. Inactive infections (like hepatitis) might become active again. 


This drug may be taken alone or with immunotherapy. Side effects might occur, such as reduced healthy blood counts. More serious side effects include pneumonia, infections, and kidney damage (tumor lysis syndrome).


Chemotherapy is commonly used to kill CLL cells. Chemotherapy drugs can be delivered through a vein or in pill form. 

Chemotherapy drugs enter the bloodstream to attack leukemia cells throughout the body (systemic chemotherapy). 

Chemotherapy may be given along with other treatment (such as an immunotherapy).

Side effects

Chemotherapy can cause mild to severe side effects, depending on the type, dose, and how long it’s given. Not everyone has the same side effects even when taking the same chemotherapy drugs.

Common side effects include:

  • Hair loss
  • Nausea and vomiting
  • Loss of appetite
  • Mouth sores
  • Fatigue
  • Low blood cell counts
  • Bleeding
  • Infections

Chemotherapy can cause dangerously low blood cell counts. You may need:

  • Medication to boost your white blood cell count.
  • Antibiotics to treat and prevent infections.
  • Transfusions of red blood cells and platelets.

We can help you manage any side effects. Be sure to let us know as soon as you develop any symptoms. Side effects typically go away after treatment ends.


Immunotherapy drugs attack the surface of the leukemia cells. Your body’s immune system can then recognize and destroy the cancer cells. 

Immunotherapy drugs are usually combined with chemotherapy, but may be used alone to treat CLL. 

Side effects

Because these drugs specifically target cancer cells, there’s less damage to healthy cells. They may still cause side effects, such as:

  • Fever
  • Chills
  • Fatigue
  • Nausea
  • Rash
  • Headaches
  • Hepatitis B reactivation

We’ll watch you closely for side effects. Let us know as soon as you notice any symptoms.

Radiation Therapy

Radiation therapy uses high-energy radiation (X-rays) to kill cancer cells. The most common type is external beam radiation therapy, which delivers radiation from a machine outside the body. 

Low doses of radiation may help relieve pain and other symptoms caused by an enlarged spleen or swollen lymph nodes. It’s also sometimes used to treat the entire body before a stem cell transplant.

Side effects

The radiation beam is often aimed at a specific part of the body. The side effects depend on the treated area but may include:

  • Hair loss
  • Skin changes, such as redness
  • Nausea and vomiting
  • Diarrhea
  • Fatigue

Let us know if you develop any side effects, we can help manage them.

Stem Cell Transplant

In leukemia, the bone marrow fills with cancer cells. Bone marrow then can’t make enough normal blood cells and platelets.

For some with high-risk CLL, we may recommend high doses of chemotherapy (or sometimes whole-body radiation) to destroy the bone marrow. After this, you’ll have a stem cell transplant. This lets the bone marrow return to making healthy blood cells. 

Stem cells are usually obtained from circulating blood. Or the cells may come from a newborn’s umbilical cord and placenta, which are rich in blood stem cells.

Although not common, we may use stem cells from a donor (allogeneic transplant). The donor may be a relative or someone whose tissue type matches yours. The closer the match, the more likely your body will accept the donor stem cells and start producing normal blood cells.

Side effects

After receiving large doses of chemotherapy (or radiation), you’re at high risk of infections and bleeding. It can take weeks to months for the bone marrow to recover. 

With donor stem cells (allogeneic transplant), your body may attack tissues of the skin, digestive tract, and liver (graft-versus-host disease). We’ll monitor you closely for signs of GVHD.

Clinical Trials

We’re always looking for new and better ways to treat CLL. Clinical trials are research studies that test new treatments or procedures that may prove better than standard treatments. 

We’ll talk with you about whether a clinical trial may be right for you.

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