Chronic Myeloid Leukemia (CML): Chemotherapy
What is chemotherapy?
Chemotherapy uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.
When might chemotherapy be used for CML?
Chemotherapy is not often used to treat chronic myeloid leukemia (CML). This is because targeted therapy medicines usually work much better. However, your doctor may advise chemotherapy if any of these applies to you:
You have a very high white blood cell count or an enlarged spleen and have not yet started targeted therapy. You may get a chemotherapy medicine called hydroxyurea for a short time to help with these problems before you start targeted therapy.
Targeted therapy medicines are not keeping your leukemia under control. Chemotherapy may help control the leukemia for a period of time.
You are having a stem cell transplant. High doses of chemotherapy are used before the transplant to kill the leukemia cells in your bone marrow.
How is chemotherapy given for CML?
If you get chemotherapy, you will meet with a hematologist/oncologist before treatment starts. This kind of doctor specializes in treating blood cancers like chemotherapy. The doctor will talk with you about your treatment and what you might expect.
Most people have chemotherapy in an outpatient part of the hospital, at a doctor's office, or at home. In some cases, you may need to stay in the hospital during treatment. This will depend on the medicines you are given and your overall health. You may take these medicines in pill form, by injection, or IV. You may take the medicines in more than one of these ways.
You get chemotherapy in cycles over a period of time. That means you may take the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is one cycle. You may have several cycles. Having treatment in cycles helps by:
Killing more cancer cells. The medicine can kill more cancer cells over time, because the cells aren't all dividing at the same time. Cycles allow the medicine to fight more cells.
Giving your body a rest. Treatment is hard on other cells of the body that divide quickly. This includes cells in the lining of the mouth and stomach. This causes side effects, such as sores and nausea. Between cycles, your body can get a rest from the chemotherapy.
Giving your mind a rest. Having chemotherapy can be stressful. Taking breaks between cycles can let you get an emotional break between treatments.
What are the medicines used to treat CML?
The medicines used most often for CML include:
Other chemotherapy medicines may also be used.
What are common side effects of chemotherapy?
Chemotherapy medicines are designed to attack and kill cells that grow quickly, including cancer cells. These medicines can also affect normal cells that grow quickly. These include follicles, intestines, mouth, and bone marrow. The side effects of chemotherapy are different for everyone. They usually go away when the treatment ends.
The most common short-term side effects of chemotherapy include:
Loss of appetite
Nausea and vomiting
Easy bruising or bleeding, from low levels of blood platelets
Tiredness, from having low levels of red blood cells
Infections, from low levels of white blood cells
Numbness, tingling, or pain in fingers or toes (neuropathy)
Possible severe side effects of chemotherapy include:
Tumor lysis syndrome. This is caused by the breakdown of large amounts of leukemia cells. It can affect your kidneys, heart, and nervous system. Your doctor will check your kidney function and do other tests to watch for this.
Organ damage. This can include damage to the kidneys, liver, testicles, ovaries, heart, or lungs.
Working with your healthcare provider
It's important to know which medicines you're taking. Write your medicines down, ask your healthcare team how they work, and what side effects they might have.
Talk with your healthcare providers about what signs to look for, and when to call them. Make sure you know what number to call with questions, even on evenings and weekends.
It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your medical team to make a plan to manage your side effects.
March 21, 2017
Alteri, Rick, MD,Cunningham, Louise, RN