Chemotherapy for chronic myeloid leukaemia
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy or damage leukaemia cells.
The drugs can be given as tablets or into a vein (intravenously). The chemotherapy circulates your blood and can reach leukaemia cells all over the body.
Although imatinib is usually the standard treatment for CML, chemotherapy is also occasionally used. It‘s most likely to be used if imatinib or other TK inhibitors aren’t effective or cause severe side effects.
Some people are given chemotherapy, usually with a tablet called hydroxycarbamide, when their CML is first diagnosed. This may happen when doctors are waiting for the results of tests to confirm the CML is of a type that’s likely to respond to a TK inhibitor. In this situation, treatment is usually changed to imatinib once the test results are available.
Usually, chemotherapy for CML involves taking a tablet, which only causes mild side effects. Occasionally, more intensive chemotherapy involving a combination of intravenous drugs is needed. This is usually used for the blast phase and causes more troublesome side effects than chemotherapy tablets.
People who are treated with a stem cell transplant usually have intensive chemotherapy as preparation for the transplant.
Chemotherapy used to treat CML in the chronic phase is usually given as tablets. The most commonly used drug is hydroxycarbamide. The doctor, nurse or pharmacist will tell you how many tablets to take. You need to be sure you’re taking the right dose.
The tablets are often taken every day for as long as they’re working. The dose of the tablets may be changed depending on the results of regular blood tests.
Treatment may be stopped for a while if the number of white blood cells falls below a certain level. For most people, the side effects from the tablets are mild.
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If CML starts to behave more like an acute leukaemia, or if you are going to have high-dose treatment with a stem cell transplant, you will be given more intensive chemotherapy. This generally consists of a combination of three or four drugs given by injection into a vein (intravenously).
Your doctor or specialist nurse will give you information about the drugs and their possible side effects.
To make having intravenous chemotherapy easier, and to prevent you from having frequent injections, a plastic tube called a central line can be put into a vein in your chest. Sometimes, instead of a central line, a PICC line (peripherally inserted central venous catheter) or an implantable port may be used.
Side effects of chemotherapy
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If you are taking a single chemotherapy tablet, any side effects you have will usually be mild. Treatment with a combination of two or more chemotherapy drugs may cause more troublesome side effects.
Risk of infection
Chemotherapy destroys the leukaemia cells in your blood, but it also temporarily reduces the number of healthy white blood cells. Your blood cell levels will be checked regularly while you’re having treatment. If your white blood cell count is too low, you will be more at risk of infection and your treatment may be delayed for a while to allow it to recover.
While having chemotherapy, you should contact your doctor or the hospital straight away if you:
have a temperature above 38˚C (100.4˚F)
suddenly feel unwell, even with a normal temperature
have other signs of an infection, such as coughing up sputum.
Anaemia, bruising and bleeding
Chemotherapy can lower the number of red blood cells and platelets in the blood. A low red blood cell count is called anaemia and can cause tiredness and breathlessness.
A low platelet count can cause blood-clotting problems and you may have bruising, nosebleeds or other abnormal bleeding. You should check for blood blisters in your mouth or a rash of pinprick-sized red spots (petechiae) on your legs.
If your red blood cells or platelets take a while to recover, you may need a blood or platelet transfusion. You can have transfusions as an outpatient.
Feeling sick (nausea)
Some chemotherapy drugs can make you feel sick (nausea) or be sick (vomit). Your doctor will prescribe anti-sickness (anti-emetic) drugs if your chemotherapy treatment could make you sick. There are several effective anti-sickness drugs available, so if you feel sick let your doctor know.
Some chemotherapy drugs can make your mouth sore and cause small ulcers. You may be given a mouthwash to use regularly. Your nurse will explain how to use it. If your mouth is sore it’s best to avoid alcohol and foods that are very hot, salty or highly spiced.
If you are having treatment with two or more chemotherapy drugs, or chemotherapy over a long period of time, you will probably feel more tired than usual. If you feel tired, plan some rest periods into your day. Try to balance rest periods with some gentle activities when you feel able.
Not all chemotherapy drugs cause hair loss. Whether you lose any hair during your treatment or not will depend on the treatment you have. Your doctor or chemotherapy nurse can tell you what to expect.
It’s important to use effective contraception during sex while you’re having chemotherapy treatment, as the drugs might harm a developing baby if you or your partner becomes pregnant.
Unfortunately, some chemotherapy treatment may cause infertility. This is the inability to become pregnant or father a child. It may be temporary or permanent, depending on the drugs you have. If you think you may want to have children in the future, talk to your doctors about this before starting chemotherapy treatment. They will be able to tell you if your fertility is likely to be affected and what options may be available.
If you have a partner, it’s a good idea for both of you to be there during these discussions. Don’t be afraid to ask your doctor or specialist nurse any questions you have.
Hear from people who've been there too
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You might find it helpful to watch our videos of people talking about their experiences of cancer and its treatment: