Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy the 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 acute myeloid leukaemia 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 to you, and there is more information in this section.

Chemotherapy is usually given as several sessions (cycles) of treatment. Each session lasts for 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 four or five 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 most commonly used induction chemotherapy drugs are cytarabine (Ara-C), daunorubicin, etoposide (Etopophos®, Vepesid®), fludarabine (Fludara®) and idarubicin (Zavedos®).

Currently two national trials (AML-15 and AML-16) 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 will 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 will 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, daunorubicin 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.

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 may be carried out using either your own, or 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 is 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 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 to have 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, which you may have for a couple of days, should be completely painless.

Once it is 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. The line can stay in for many months. The nurses will show you how to care for it to prevent blockages or infection. Blood can be taken from the line for testing and blood transfusions can also be given through it.

Sometimes a PICC (peripherally inserted central catheter) line can be used instead of a central line. A thin tube is inserted into a vein in the crook 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 the sections on blood transfusions and platelet transfusions for further information.

Lowered resistance to infection

While the chemotherapy drugs are acting on the leukaemia cells in your body, they also reduce the number of normal cells in your blood for a while. 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 will probably be given tablets or other medicines to reduce the risk of certain types of infection.

If you get an infection, you will be treated for it straight away. Most infections are caused by bacteria, fungi or viruses already present in your own body, or in the environment. These do not normally cause infection, but when your immunity is low they are more likely to cause a problem.

It is 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 give you information on how to prepare foods and which foods to avoid.

If your temperature goes above 37.5ºC (100ºF) or you suddenly feel unwell, even with a normal temperature, contact your doctor or nurse at the hospital straight away.

Anaemia

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.

Increased risk of bruising and bleeding

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, contact the hospital immediately.

Tiredness (fatigue)

This is a very common side effect of chemotherapy. 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.

Changes to the way that your heart works

Some of the drugs used to treat acute myeloid leukaemia may affect the heart muscle. The doses of the chemotherapy drugs are carefully monitored, and heart tests may be done from time to time to check your heart function.

Sore mouth

Some chemotherapy drugs can make your mouth sore and cause mouth 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.

Feeling sick

Some of the drugs used to treat acute myeloid leukaemia 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 that they can change them for other drugs, which may be more effective.

Hair loss

Hair loss is another common side effect of these drugs. 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.

Chemotherapy affects different people in different ways. Some find they are able to 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.