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Side effects of chemotherapy for acute myeloid leukaemia

 Men and women discussing acute myeloid leukaemia

This page tells you about chemotherapy drugs for acute myeloid leukaemia (AML) and their side effects. You can find the following information

 

A quick guide to what's on this page

Side effects of chemotherapy for acute myeloid leukaemia

Most people with acute myeloid leukaemia have a combination of 2 or more chemotherapy drugs as induction treatment. The drugs most commonly used are high dose cytarabine (Ara-C or cytosine) and daunorubicin. Most people have 2 courses of this treatment. 

To stop the AML coming back (consolidation treatment), doctors often use a combination of drugs which may include amsacrine, cytarabine, etoposide, daunorubicin, fludarabine or idarubicin. Your doctor will tell you what combination of drugs you will have.

Some people may have high dose chemotherapy as part of a stem cell or bone marrow transplant.

People with the M3 type of AML (promyelocytic leukaemia or APL) also have a drug called all trans retinoic acid (ATRA). You often have this alongside chemotherapy. ATRA lowers the risk of bleeding and makes the APL more likely to go into remission. You may also have treatment with a drug called arsenic trioxide (ATO). You are most likely to have this for APL that has not gone into remission or has come back.

AML chemotherapy side effects

Drugs affect people in different ways. It is not possible to tell how you will react until you have a particular drug. The common side effects of chemotherapy for AML are

  • A drop in your blood cell counts
  • Feeling and being sick
  • Complete hair loss (the hair grows back after treatment)
  • A sore mouth and mouth ulcers
  • Diarrhoea
  • Tiredness
  • Changes in fertility (the treatment will probably make you infertile)

You will be at risk of infection for a few weeks after your treatment. During AML treatment, most people will need antibiotics into a vein for infection at some time. You may need blood transfusions to top up your red blood cells. You will also have a low platelet count at some point in your treatment. This means you are at risk of bleeding or bruising. You can have platelet transfusions to top up your platelets.

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating AML section.

 

 

Chemotherapy drugs for AML

Most people with acute myeloid leukaemia have a combination of 2 or more chemotherapy drugs to get rid of the leukaemia (remission induction). The drugs doctors most commonly use are high dose cytarabine (Ara-C or cytosine) and daunorubicin. People usually have 2 courses of these drugs.

But doctors may also use other drugs such as 

People with the M3 type of AML (promyelocytic leukaemia) also have a drug called all trans retinoic acid, which is also called ATRA or tretinoin.

People who are not well enough for standard chemotherapy may have a low dose of cytarabine (Ara-C)

To help stop the leukaemia coming back (consolidation treatment) doctors use a combination of drugs. These may include

Some people may have high dose chemotherapy as part of a bone marrow or stem cell transplant

Another chemotherapy drug that doctors may use is azacitidine. You may have this if you are unable to have a stem cell or bone marrow transplant.

The links above take you to information about the specific side effects of each of these drugs. You won’t have all of the side effects listed. Your doctor or nurse will tell you which combination of drugs you will have and the possible side effects.

You may have radiotherapy as part of a bone marrow transplant.

 

Drugs for acute promyelocytic leukaemia (APL)

As well as chemotherapy, people with acute promyelocytic leukaemia (APL, or AML type M3) may have other drugs. These are

ATRA

ATRA stands for all trans retinoic acid. It is also called tretinoin. ATRA is not a chemotherapy drug. It belongs to a group of drugs called retinoids, which are made from vitamin A. You may have ATRA alongside the standard chemotherapy treatments for AML.

ATRA lowers the risk of bleeding from chemotherapy and makes the APL more likely to go into remission. You usually take ATRA until your leukaemia has gone into remission and then for a while longer (a maintenance period). This is to help keep it in remission. There is information about ATRA and its side effects in the cancer drugs section.

Arsenic trioxide

Arsenic trioxide (ATO) is a drug that works by speeding up the death of leukaemic cells and encourages normal blood cells to mature properly. You are most likely to have this treatment for acute promyelocytic leukaemia (APL) that has not gone into remission or has come back. 

You have it as a drip into your bloodstream. As with all drugs, arsenic trioxide has side effects. These can include 

  • Tiredness (fatigue)
  • Muscle and bone pain
  • A high temperature (fever)
  • Stomach pain
  • Headaches
  • Raised blood sugar levels

There is more information about arsenic trioxide and its side effects in the cancer drugs section.

 

AML chemotherapy side effects

Drugs affect people in different ways. They can have different side effects with the same drug. It is not possible to tell how you will react until you have a particular drug.

The common side effects you are likely to have with chemotherapy for acute myeloid leukaemia are

The links above take you to information on other pages about the individual side effects. 

All the drugs used to treat AML make your blood cell counts fall. This includes your

You will be at risk of infection for a few weeks after your treatment. At some point during AML treatment, most people will need to have antibiotics into a vein for an infection.

After about a month you will be at risk of a low red blood cell count (anaemia), and may have blood transfusions to top up your red cells. 

You will also have a low platelet count at some point in your treatment. This means you are at risk of bleeding or bruising. You can have platelet transfusions to top up your platelets.

The chemotherapy drugs for AML will make your hair fall out. It will grow back after your treatment ends. But during your treatment you will lose

  • The hair on your head
  • Your body hair
  • Your eyebrows and eyelashes
  • The hair inside your nose – so your nose will run more than usual

Chemotherapy for adult leukaemia nearly always makes you infertile. You should talk to your doctor about this. Men may be able to store sperm to use later. It may be possible for women to store eggs. But unfortunately this is not usually possible, as your doctors need to start your leukaemia treatment straight away and egg collection takes quite a few weeks. There is information about sex, fertility and acute myeloid leukaemia in the living with AML section.

 

Controlling the effects of AML treatment

Chemotherapy drugs can cause some effects that need to be controlled. Substances from dying leukaemia cells can cause problems with your liver and kidneys. This is called tumour lysis syndrome. To control this, you may have medicines such as allopurinol tablets. These tablets help the body to process the extra waste materials from the dead leukaemia cells.

Chemotherapy drugs also increase your risk of infection. To help stop you getting infections from the natural bacteria that live in the gut, you may need to take tablets called gut sterilisers. You may also need tablets and mouthwashes to help stop mouth infections, such as thrush.

 

Taking part in clinical trials

Your specialist may ask you to take part in a clinical trial. This is so that doctors can find out which treatments work best and help patients in the future. Trials also look at

  • Reducing side effects of the treatment
  • Giving treatment in different ways

The aim of the treatment is to make you feel better. So it is important that the chemotherapy itself doesn’t make you feel too ill. And it is also important that you don't have to make too many trips to the hospital.  

You can look on our clinical trials database for AML trials. Choose ‘leukaemia’ and then ‘acute leukaemia’ from the dropdown menu. Tick the boxes for closed trials and trial results if you want to see all the trials.

 

Supplements, herbal treatments and chemotherapy

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Tell them if you are prescribed therapies by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

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Updated: 15 February 2014