Chemotherapy for chronic myeloid leukaemia (CML)

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

Targeted cancer drugs such as imatinib are usually the first treatment for most people with chronic myeloid leukaemia (CML). But some people might need to have chemotherapy.

When you have it

You might have chemotherapy:

while you are waiting for test results to confirm your diagnosis - this is to reduce your white blood cell count or to control symptoms
if your CML is in the blast phase
before a stem cell transplant

Types of chemotherapy

Lowering your white blood cell count

You might have a chemotherapy drug called hydroxycarbamide. This aims to reduce your white blood cell count and control any symptoms you might be having. You take hydroxycarbamide as capsules.

Treating blast phase CML

The drugs you have for the blast phase of CML are the same as for acute myeloid leukaemia (AML). You usually have a combination of chemotherapy drugs into your bloodstream through a drip. You might take a tyrosine kinase inhibitor (TKI) drug alongside the chemotherapy.

High dose chemotherapy

Your doctor might suggest high dose chemotherapy treatment followed by a stem cell or bone marrow transplant. You might have this if your CML has not responded to previous treatment with tyrosine kinase inhibitors (TKIs).

You need to:

be reasonably fit to have a stem cell or bone marrow transplant
go into hospital to have high dose chemotherapy through a drip

This treatment is intensive and not suitable for everyone. You have a high risk of picking up an infection afterwards and will need to stay in hospital for a few weeks at least.

How you have chemotherapy

You might take chemotherapy as capsules, or have it directly into your bloodstream (intravenously).

Taking your capsules or tablets

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.

Into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Where you have chemotherapy

You can usually take chemotherapy capsules at home. Your doctor or pharmacist gives you instructions on when and how to take them.

You have treatment that goes into your bloodstream through a drip at the cancer day clinic or as an inpatient on the ward. It can take several hours to have chemotherapy so it’s a good idea to have something to read to help to pass the time. A friend or family member can usually be with you to keep you company.

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Transcript

Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.

So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.

Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?

Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.

Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.

So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.

So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.

Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.

Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.

All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.

So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.

So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.

Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

take any supplements
have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

Side effects

Common chemotherapy side effects include:

feeling sick
loss of appetite
losing weight
feeling very tired
increased risk of getting an infection
bleeding and bruising easily
diarrhoea or constipation
hair loss

Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

which drugs you have
how much of each drug you have
how you react

Tell your treatment team about any side effects that you have.

When you go home

Chemotherapy for CML can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.