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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
Find out how we produce our information|
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy or damage leukaemia cells|. It works by disrupting the way leukaemia cells grow and divide. As the drugs circulate in the blood they can reach leukaemia cells all over the body.
The main aim of treatment for AML is to try to cure it. The first step is to achieve a remission. This means that the abnormal, immature cells – or blasts – can no longer be detected in your blood or bone marrow|, and normal bone marrow has developed again.
When you are in remission there may still be a small number of abnormal cells in your body, even though doctors can no longer detect any signs of the leukaemia. So you will need to have further chemotherapy to reduce the risk of the leukaemia coming back.
The doctors will monitor you closely to see how well your leukaemia is responding to the chemotherapy. They will plan what further treatment is necessary depending on how the leukaemia responds.
Our section on chemotherapy| discusses the treatment and its side effects in more detail. Information about individual drugs| and their particular side effects is also available.
The chemotherapy drugs are usually given by drip or injection through a thin, flexible plastic tube. The tube is inserted under the skin and into a vein near the collarbone (central line| or Hickman® line), or passed through a vein in the arm (PICC line|).
Your doctor or nurse will explain more about this, and there is more information below|.
Chemotherapy is usually given as several sessions (cycles) of treatment. Each session lasts 5–10 days and is followed by a rest period of three to four weeks. This rest period allows your body to recover from the side effects of the treatment. Most people have three or four cycles of chemotherapy. The complete course of treatment can last about six months.
The first cycles of chemotherapy are called induction chemotherapy. Most people have two cycles of induction chemotherapy. You may be able to go home between treatments if you are well enough. The possible side effects| of the treatment are outlined below.
The most commonly-used induction chemotherapy drugs are:
Currently two national trials called AML-16 and AML-17| are being carried out. One of the things the trials are trying to find out is whether giving a monoclonal antibody called gemtuzumab (Mylotarg®) with chemotherapy is better than chemotherapy alone. See newer treatments| for information about gemtuzumab.
If the induction chemotherapy does not destroy all of the leukaemia cells, you’ll be given further cycles of chemotherapy aimed at getting the leukaemia into remission.
If there is no sign of the leukaemia in your bone marrow after induction chemotherapy, you’ll be given further cycles of chemotherapy to reduce the risk of the leukaemia coming back. This is known as consolidation treatment. The most commonly used drugs for consolidation chemotherapy are cytarabine, etoposide, amsacrine and mitoxantrone.
For some people, high-dose chemotherapy with a stem cell or bone marrow transplant| may be helpful. The doctor will consider whether chemotherapy alone is likely to cure the leukaemia. They will take into account the results of the cytogenetics tests and your response to induction chemotherapy.
If there is a high risk that your leukaemia will come back after chemotherapy, your doctor may suggest that you have high-dose chemotherapy, or chemotherapy with radiotherapy|, followed by a transplant. The transplant will be carried out using a donor’s stem cells or bone marrow.
This may be the best option for people who are not fit enough to have intensive chemotherapy and for people who choose not to have intensive treatment. It’s aimed at controlling the number of leukaemia cells in the bone marrow but gives a lower chance of remission. The chemotherapy drugs may be given by drip or infusion, by mouth or by injection under the skin (subcutaneous). It can often be given on an outpatient basis.
One part of the AML-16 trial is looking at ways to improve the effectiveness of low-dose treatment by adding other newer types of drugs to the most commonly-used drug cytarabine (Ara-C). See newer treatments| for more information.
To make it easier to give the chemotherapy drugs, and to avoid having frequent injections, a plastic tube called a central line or Hickman® line can be put into a vein in the chest. The line is put in under a general or local anaesthetic and, apart from a stiff shoulder for a couple of days, should be completely painless. Once it’s in place, the central line is either stitched or taped firmly to your chest to prevent it from being pulled out of the vein.
Drugs are given through the tube directly into your bloodstream. Blood samples can be taken from the line and blood transfusions| can also be given through it.
The line can stay in for many months. The nurses will show you how to care for it to prevent blockages or infection.
A central line
Sometimes a PICC line can be used instead of a central line. A thin tube is inserted into a vein in the bend or upper part of your arm. This can stay in place for several months.
During your treatment you will also have supportive care.
This treats the symptoms that are caused by a lack of normal blood cells and often involves having transfusions of red blood cells and platelets from time to time.
See our sections on blood transfusions| and platelet transfusions| for further information.
Chemotherapy drugs can cause side effects, but these can often be well managed with medicines and supportive care. Your doctor or specialist nurse will tell you more about what to expect. Most of these side effects usually improve and go away when your treatment is over. Common side effects of chemotherapy include:
The above side effects are short-term. Some side effects can cause longer-term problems, including:
While the chemotherapy drugs are acting on the leukaemia cells in your body, they also reduce the number of normal white cells for a while (neutropenia). When white blood cells are in short supply, you are more likely to get an infection|.
During chemotherapy your blood will be tested regularly.
You’ll probably be given tablets or other medicines to reduce the risk of certain types of infection. If you get an infection, you’ll be treated for it straight away. Most infections are caused by bacteria, fungi or viruses already present in your body or the environment. These do not normally cause infection, but when your immunity is low they are more likely to cause a problem.
It’s best to avoid coming into contact with people who may have an infection. You may also be advised to be careful about what you eat, in order to guard against the risk of infection from raw, undercooked or contaminated food. The hospital will inform you how to prepare foods and which foods to avoid.
If your temperature goes above 38°C (100.4°F) or you suddenly feel unwell, even with a normal temperature, contact your doctor or nurse at the hospital straight away. If your white cell count stays very low for a long time you may be given injections of a drug called growth factor (G-CSF|) to help it recover more quickly.
If the level of red blood cells in your blood is low you may become very tired and lethargic. You may also become breathless|. These are all symptoms of anaemia – a lack of red blood cells in the blood.
Anaemia can be treated by blood transfusions.
Platelets help your blood to clot. When you have leukaemia, the number of platelets in your blood is lower than normal, and chemotherapy may temporarily reduce the numbers even more. This means that you may bruise very easily, and may bleed heavily from even minor cuts and grazes.
You may need to have a transfusion of platelets before your chemotherapy begins, and at times during your treatment, to increase the number of platelets.
If you develop any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums, contact the hospital immediately.
This is a very common side effect. The fatigue| may be caused by anaemia, but may also be due to chemotherapy, even if your blood count is normal. You may be especially aware of this when you are at home between cycles of chemotherapy, and for a few months after the treatment has finished. It can help to cope with tiredness by planning ahead. Keeping a treatment diary can help you record your energy levels and plan activities for when you are feeling stronger.
Some chemotherapy drugs can make your mouth sore| and cause ulcers. Regular mouthwashes are important and the nurses will show you how to use these properly. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. A nurse or dietitian at the hospital can give you advice about how to eat well| during your chemotherapy if your mouth is sore.
Some of the drugs used to treat AML may make you feel sick and may sometimes cause vomiting. There are now very effective anti-sickness drugs (anti-emetics) to prevent or greatly reduce nausea and vomiting|. Your doctor will prescribe these for you. If you still feel sick, despite the anti-emetics, let your doctor or nurse know so they can change them for other drugs, which may be more effective.
Hair loss| is another common side effect. This can be very upsetting. If your hair falls out it should start to grow back over a period of 3–6 months once the treatment ends. There are many ways of covering up, including wigs, hats or scarves.
You may be entitled to a free wig from the NHS and your doctor or one of the nurses on the ward can arrange for a wig specialist to visit you. We have a booklet called Coping with hair loss, which discusses practical ways of dealing with hair loss and how to cope with the emotional effects.
Chemotherapy affects people in different ways. Some find they can lead a fairly normal life during their treatment, but many find they become very tired and have to take things much more slowly. Do as much as you feel like and try not to overdo it.
Although they may be hard to deal with at the time, most of these side effects will disappear once your treatment is over.
Some of the drugs used to treat AML may affect the heart muscle. These drugs are called anthracyclines and include daunorubicin| and idarubicin|. This doesn’t affect everyone who has these drugs and is usually a temporary side effect, but can sometimes lead to long-term heart problems. Your heart function will be carefully monitored during and after treatment and the drugs you are given may be altered if any heart problems occur.
Some of the drugs used to treat AML can cause temporary or permanent infertility|. Your doctor will talk to you about this in more detail before you start your treatment. If you have a partner, you may want them to be with you so you can discuss any fears or worries together.
Some drugs have less effect on your fertility than others, and couples have had normal, healthy babies after one partner has been treated for leukaemia. Unfortunately, people who’ve had intensive chemotherapy and radiotherapy, and a stem cell or bone marrow transplant, are likely to be permanently infertile.
It may be possible for men to store sperm before starting treatment, so it can be used later if they want to have a family. Rarely, a woman’s eggs or fertilised eggs (embryos) can be stored before chemotherapy, so that she may have the chance to have a child after treatment. However, as treatment for AML usually needs to start as quickly as possible, there is not always enough time to store sperm or embryos.
We have information about sperm banking and fertility treatments|.
It can be very difficult to come to terms with the fact that you can no longer have children. Talking about your feelings with your partner, family or a close friend can help to clarify your thoughts and give the people close to you the opportunity to understand how you are feeling.
If it would be easier to talk to someone outside the circle of your immediate friends and family, you may find it helpful to talk to your doctor, nurse, social worker or a trained counsellor. You can also contact some of the support organisations| listed in our database for help.
Our cancer support specialists can give you information about how to contact a counsellor in your area. Call our Macmillan Support Line free on 0808 808 00 00.
We have a section that discusses Sexuality and cancer|, which looks at the effects cancer and its treatment can have on sexuality and fertility. We also have information about sex, relationships and fertility for young people affected by cancer|.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.