Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy the leukaemia cells. They work by damaging both the normal and leukaemia cells. The normal cells can repair any damage caused by the chemotherapy but the leukaemia cells are likely to die. As the drugs circulate in the blood they can reach leukaemia cells all over the body.

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.

Chemotherapy tablets

The chemotherapy used to treat CML in its chronic phase is usually given as tablets – often taken daily, and continuously. The dose of the tablets will be changed depending on the results of regular blood tests. Treatment will be stopped if the number of your white blood cells falls below a certain level. For most people the side effects from the tablets are mild. The drug most commonly used is hydroxyurea.

Chemotherapy injections

When CML starts to behave more like an acute leukaemia, more intensive chemotherapy is the main treatment. It generally consists of a combination of three or four drugs given by injection into a vein (intravenously).

Central line

To make giving the chemotherapy easier and to prevent you from having frequent injections, a plastic tube (called a central line) may be put into a vein in your chest. The tube is inserted under a general or local anaesthetic. Usually a small cut (incision) will be made in the skin over your chest, and a thin flexible plastic tube will be placed under your skin and into a large vein in your neck. The other end of the tube stays outside your body and has a screw cap at the end. The tube can be used to give drugs and fluids and also to collect blood samples.

You may be in some discomfort for a couple of days after the line has been put in, but it should then be painless. It can stay in for months and the nurses will show you how to look after it to prevent blockages or infections.

PICC line

Instead of a central line a PICC line (peripherally inserted central venous catheter) or a portacath may be used. A PICC line is a long, fine tube put into a vein in the crook of your arm. The doctor or chemotherapy nurse will explain the procedure to you. You will be given a local anaesthetic before the line is put in.

Implantable port

A portacath (also known as an implantable port) is a thin, soft plastic tube that is put into a vein in the chest and has an opening (port) just under the skin on your chest or arm.

During your treatment you will also have medicines or treatments to control the effects on the body caused by a lack of normal blood cells due to the leukaemia itself or to the chemotherapy. Transfusions (drips) of red cells and platelets are often needed to replace the normal blood cells. The transfusions can also be given through your central line.

Chemotherapy tablets given for CML usually cause few side effects. Side effects are generally more severe with the chemotherapy given into a vein (intravenously).

Lowered resistance to infection

While the 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 these cells are in short supply, you are more likely to get an infection. During chemotherapy your blood will be tested regularly. You may be given tablets or other medicines to reduce the likelihood of certain types of infection.

If you get an infection, you will be given antibiotics to treat it. Most infections come from normal bacteria which live in the skin or in the bowel. However, if your immunity is low it is best to avoid crowded places where you may come into contact with anyone who may have an infection.

If your temperature goes above 38ºC (100.5ºF) or you suddenly feel ill, even with a normal temperature, contact your doctor or the hospital straight away.

Anaemia

If the level of red blood cells (haemoglobin) 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 haemoglobin in the blood.

Anaemia can be very successfully treated by blood transfusions. You will feel more energetic and the breathlessness will be eased. Sometimes a drug called erythropoietin can be used to increase the production of red cells by the bone marrow.

Tiredness (fatigue)

Fatigue is a very common effect of chemotherapy and may be due to anaemia, but may also occur as a result of chemotherapy, even if your red blood cell level is normal. It can last for a few months after the treatment has finished.

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 more heavily from even minor cuts and grazes.

To replace the missing platelets, you may need to have a drip (transfusion) of platelets before your chemotherapy begins, and at times during your treatment.

If you develop any unexplained bruising or bleeding contact the hospital immediately.

Feeling sick

Some of the drugs used to treat CML may make you feel sick (nauseated) and you may actually be sick. 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.

Sore mouth

Some chemotherapy drugs can make your mouth sore and cause mouth ulcers. Regular mouthwashes are important and the nurse will show you how to do these properly.

If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. Your nurse or a dietitian at the hospital can give you advice about ways to boost your diet.

Hair loss

The drugs used to treat CML in its chronic phase do not usually make your hair fall out, unless you have a stem cell or bone marrow transplant. Unfortunately, the drugs used in the blast phase do cause hair loss.

People who lose their hair often cover this up by wearing wigs, hats or scarves. Most patients are 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. If your hair falls out, it will grow back over a period of 3–6 months once the treatment has finished.

Although they may be hard to bear at the time, the side effects mentioned above will disappear once your treatment is over.

Chemotherapy affects different people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many find that 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. Some chemotherapy can affect your fertility.