Chronic Myeloid Leukemia (CML): Chemotherapy

What is chemotherapy?

Chemotherapy uses strong 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 CML. This is because targeted therapy medicines usually work much better. Still, your healthcare provider may advise chemotherapy if any of these applies to you: 

• 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? 

Most people have chemotherapy in an outpatient part of the hospital, at ahealthcare provider'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 get these medicines in pill form, by injection, or through a vein (IV). You may get the medicines in more than one of these ways. 

You get chemotherapy in cycles over a period of time. That means you may get 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. Chemotherapy can also cause a drop in healthy blood cells. 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 medicines are used to treat CML?

The medicines used most often for CML include:

• Cytarabine

• Omacetaxine 

Other chemotherapy medicines may also be used. When chemotherapy is used for CML, it's often the same drugs used to treat another type of leukemia called AML, or acute myeloid leukemia.

What are common side effects of chemotherapy?

Chemotherapy medicines attack and kill cells that grow quickly, including cancer cells. These medicines can also affect normal cells that grow quickly. These include hair follicles, the lining of the mouth and intestines, and the bone marrow where healthy blood cells are made. 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

• Increased chance of infections, from low levels of white blood cells

• Hair loss

• Diarrhea

• Mouth sores

• 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. Fluid may be given to you through a vein to help keep this from happening. 

• Organ damage. This can include damage to the kidneys, liver, testicles, ovaries, heart, or lungs. Your healthcare provider will keep an eye on you for serious side effects. 

Working with your healthcare provider

It's important to know which medicines you're taking. Write down your medicines. Ask your healthcare team how they work, and what side effects they might have.

Talk with your healthcare providers about what signs to watch out for and when you should call your healthcare team. 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 any 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.