Side effects of chemotherapy for acute myeloid leukaemia

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 most commonly used are high dose cytarabine (Ara-C) and daunorubicin. People usually have 2 courses of these drugs.

But doctors may also use other drugs such as 

• Idarubicin
• Mitoxantrone
• Etoposide
• Thioguanine
• Fludarabine

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 have a low dose of cytarabine (Ara-C). 

To help stop the leukaemia coming back (consolidation treatment) doctors commonly use a combination of amsacrine, cytarabine, and etoposide. This treatment is often followed by a combination of mitoxantrone and cytarabine.

Other drugs that may be used include 

• Mercaptopurine
• Azacitidine
• High dose chemotherapy as part of a bone marrow or stem cell 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 ones you may have.

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

People with acute promyelocytic leukaemia (APL, or AML type M3) have a drug called ATRA alongside the standard chemotherapy treatments for AML. 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.

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), to help keep it in remission. There is information about ATRA in the cancer drugs section.

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 treatment for acute myeloid leukaemia are

• A drop in your blood cell counts
• Feeling and being sick
• Complete hair loss
• A sore mouth and mouth ulcers
• Diarrhoea
• Tiredness
• Changes in fertility

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

• Red blood cells
• Platelets
• White blood cells

You will be at risk of infection for a few weeks after your treatment. During AML treatment, at some point most people need to have antibiotics, given 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 AML chemotherapy drugs will also 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 usually it is not possible, as your doctors need to start your leukaemia treatment straight away and egg collection takes quite a few weeks.

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.

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.

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.