Even in long-term disease remission, whether on continuous therapy or after completing time- limited therapy, patients with CLL may have prolonged immune compromise, risk of developing hypogammaglobulinemia, and greatly increased risk of both melanoma and non-melanoma skin cancers.

UV precautions and regular skin checks are recommended. It is also important to ensure patients stay up to date with recommended vaccinations including annual seasonal influenza and five-yearly pneumococcal vaccinations.

While patients are at continuing risk of herpes zoster reactivation, they are also immunocompromised and may not be suitable for zoster vaccination with live attenuated formulations, so inactivated formulations may be preferred, if available. Specialist infectious diseases guidance may be appropriate (Schmid et al. 2021).

For more information on supportive care and needs that may arise for different population groups, see Appendices A, B and C.