Chronic lymphocytic leukemia (CLL) is a type of cancer that affects white blood cells called lymphocytes in the bone marrow and blood. CLL causes lymphocytes to grow out of control, which can lead to a variety of symptoms and complications. One common question CLL patients have is whether the disease or its treatment will cause them to gain weight.
Does CLL itself cause weight gain?
CLL itself does not directly lead to weight gain in most patients. However, there are some indirect ways that having CLL can potentially contribute to weight gain:
Fatigue and low energy
Many patients with CLL experience extreme fatigue and lack of energy due to the buildup of abnormal lymphocytes. This lack of energy can make it difficult to exercise and be active, which can promote weight gain over time.
Enlarged spleen
In some CLL cases, the spleen becomes enlarged due to the accumulation of abnormal lymphocytes. An enlarged spleen may cause a sensation of fullness, loss of appetite, and early satiety, which can lead to decreased food intake and unintended weight loss. However, once the enlarged spleen is treated, appetite often rebounds and patients may start regaining weight.
Infection risk
CLL weakens the immune system and increases susceptibility to infections. Serious infections often cause patients to lose their appetite. As the infection resolves and appetite increases, patients may eat more to make up for lost calories and gain weight.
Stress and emotional eating
Being diagnosed with cancer and undergoing treatments can be extremely stressful. Some patients may cope by eating more or craving high-calorie comfort foods, which can lead to weight gain. Managing stress and associated emotional eating may help prevent excess weight gain.
Do CLL treatments cause weight gain?
While CLL itself does not directly cause weight gain in most cases, many of the treatments used to manage CLL can increase the likelihood of weight gain:
Steroid medications
Corticosteroids like prednisone and dexamethasone are commonly used during CLL treatment. Steroids can increase appetite and lead to excess calorie intake and weight gain. They may also cause the body to hold on to fluid and redistribute fat to the trunk area.
Chemotherapy
Chemotherapy medications kill fast-growing cancer cells but can also damage healthy cells. Side effects like nausea, vomiting, sores in the mouth, changes in taste, and fatigue can lead to decreased physical activity and increased calorie intake, resulting in weight gain.
Some types of chemo are more likely to cause weight gain than others. Steroid-containing regimens like R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) frequently cause weight gain.
Targeted therapies
Newer targeted cancer medications are associated with weight gain as well, including:
- Ibrutinib
- Acalabrutinib
- Venetoclax
These drugs work by blocking specific pathways that cancer cells need to grow. Side effects like fatigue and GI issues can decrease activity levels and increase weight.
Low blood cell counts
Many CLL treatments, especially chemotherapy, can cause low blood counts. Low white blood cells raise infection risk, potentially leading to poor appetite and later increased eating. Low red blood cells (anemia) can cause fatigue, reducing activity. Low platelets raise risk of bleeding, which may limit ability to exercise. Any of these side effects could indirectly promote weight gain.
How much weight is gained on average with CLL treatments?
The amount of weight gain experienced during CLL treatment varies widely among patients based on the treatment regimen, duration of therapy, and individual factors.
Some general statistics on average weight gain with CLL treatment include:
- Prednisone: 5-15 lbs over 3-6 month course
- R-CHOP chemotherapy: 5-10 lbs over 3-6 months
- Ibrutinib: 5-10 lbs over 12-24 months
- Acalabrutinib: 3-5 lbs over 12-24 months
- Venetoclax: 2-7 lbs over 6-12 months
Of course, these are just general estimates. Some patients gain very little weight on these therapies, while others gain much more. Weight gain also tends to be more pronounced in younger, pre-menopausal women.
Factors that influence weight gain with CLL treatment
Several factors can influence an individual patient’s likelihood of gaining weight during CLL therapy:
Type of treatment
As mentioned above, certain medications like steroids and some chemotherapy regimens are more prone to causing weight gain than others. The type of treatment matters.
Duration of treatment
Longer treatment duration gives more time for possible weight gain. For example, taking steroids for 6 months often leads to more weight gain than a short 1 month course.
Dose intensity
Higher medication doses can cause more severe side effects like fatigue, nausea, etc. These side effects impact appetite, calorie intake, and activity levels.
Age & gender
Weight gain is more common in younger patients and tends to be greater in women than men. Post-menopausal women tend to gain less treatment-related weight.
Baseline weight & BMI
Patients who are overweight or obese prior to starting treatment tend to gain more weight than normal/underweight patients.
Physical activity
Patients who remain physically active typically gain less weight than sedentary patients. Activity helps burn extra calories.
Diet & eating habits
Overeating, excess snacking, and poor food choices promote weight gain. Patients who eat a healthy diet tend to gain less.
Tips to prevent weight gain during CLL treatment
To help avoid excessive weight gain during CLL therapy, consider the following tips:
Follow an eating plan
Work with a nutritionist or registered dietitian to create a structured eating plan that covers your nutrient needs without overdoing calories. Focus on lean proteins, fruits, vegetables, whole grains, and healthy fats. Limit processed foods, sugars, salt, and refined carbs.
Portion control
Use smaller plates, bowls, and glassware to help control portion sizes. Read food labels and stick to single serving sizes. Measure snacks. Avoid going back for seconds.
Increase activity
Stay as active as possible during treatment. Do light exercise like walking, swimming, or stretching daily. Increase the duration and intensity of exercise during times when your counts and energy levels are higher.
Drink water
Stay well hydrated with water and other low/no calorie beverages. Sometimes increased hunger is actually thirst in disguise. Avoid sugary and high-calorie drinks like soda, juice, and alcohol.
Manage stress
Make time for relaxation every day through techniques like meditation, yoga, deep breathing, journaling, or listening to music. Get counseling support if you are struggling emotionally.
Get rest
Make sleep a priority and aim for 7-9 hours per night. Rest helps the body heal and metabolize nutrients. Sleep deficiency can disrupt metabolic hormones.
Seek support
Enlist the help of family and friends or join a support group. Having a strong support network makes it easier to make positive lifestyle choices.
Is weight gain inevitable with CLL treatment?
Weight gain is a very common side effect of many CLL treatments, but it is not an inevitable certainty for all patients. The likelihood of gaining weight can be significantly reduced through close monitoring, lifestyle strategies, and making nutrition and activity a priority during cancer therapy.
While some slight weight fluctuations may be unavoidable, most patients can prevent significant weight gain with proper planning. It is important to discuss weight management proactively with your healthcare team and take steps to get ahead of potential issues. Staying committed to healthy habits, closely monitoring your weight trends, and asking for help when needed can help keep weight under control during treatment.
When to seek medical advice
Make sure to consult your healthcare provider if you experience any of the following:
- Rapid weight gain or loss of more than 10 pounds in one month
- Severe fatigue, weakness, or frailty
- Poor appetite or difficulty eating lasting more than two weeks
- Nausea, vomiting, or diarrhea preventing adequate nutrition
- Sudden increased swelling or fluid retention in legs, feet, or abdomen
Any significant or persistent changes in weight or eating habits should be evaluated promptly. Your medical team can check for underlying causes like depression, low blood counts, fluid retention, infections, thyroid issues, or medication side effects. They may be able to offer interventions like appetite stimulants, nutrition supplements, diuretics, or medications to improve energy levels and activity tolerance. Don’t hesitate to ask for help managing your weight during treatment.
The bottom line
While CLL itself does not directly cause weight gain in most patients, many of the commonly used CLL therapies like steroids and certain chemotherapy regimens do frequently cause weight gain due to effects like increased appetite, fluid retention, and reduced activity from fatigue. However, with mindful eating choices, regular activity, and close monitoring, most patients are able to prevent or minimize treatment-related weight gain. Work closely with your medical team and utilize all available resources to maintain the healthiest weight possible during your CLL treatment.