About chemotherapy for chronic myeloid leukaemia (CML)

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body.

Chemotherapy used to be the standard treatment for newly diagnosed CML. Now you are more likely to have treatment with imatinib (Glivec) rather than chemotherapy.

If, for some reason, you cannot take Glivec, CML also responds to treatment with chemotherapy or the biological therapy, interferon. The chemotherapy drug most commonly used is hydroxycarbamide (this used to be called hydroxyurea). Another drug you may have is busulfan, although doctors use this much less often than hydroxycarbamide.

If your CML doesn't respond well to Glivec, or becomes resistant to it, your doctor may suggest intensive treatment with a bone marrow or stem cell transplant. While we don't know yet if Glivec is a cure, transplant remains the only possible way of curing some people with CML.

You have to be reasonably fit to have a bone marrow or stem cell transplant. You will have to go into hospital and have high dose chemotherapy through a drip. Because this treatment is quite intensive, you will have a high risk of picking up an infection afterwards. You will need to stay in hospital for a few weeks at least. There is more about bone marrow and stem cell transplant in this section of CancerHelp UK.

If you are taking chemotherapy tablets at home, it is important that you take them correctly and store them safely. Follow the instructions from your pharmacist that come with the tablets. Chemotherapy tablets or capsules are dangerous if they are not prescribed for you. So you must be particularly careful about storing your tablets if children visit or live with you. The tablets should preferably be locked up, or at least kept somewhere where children can't get at them.

Your doctor will ask you to come for regular blood tests throughout your course of treatment. These are to check your white blood cell, red blood cell and platelet counts.

If you are having chemotherapy into your bloodstream, you will need to go to the hospital for treatment. Depending on the drug, you may have your chemo by injection into a vein over a few minutes, or through a drip over a longer period. Before each treatment, you will have a blood test to check your white blood cell, red blood cell and platelet counts.

Unless you are having intensive chemotherapy, you usually have chemo in the outpatient clinic and you can go home the same day. With some drugs, you have to stay in hospital overnight. This may be because the drug needs to go in very slowly. Or because you need to have fluids through your drip to flush it out of your system.

For more intensive high dose treatment, you will be in hospital for longer. As you will need quite a few drugs, your doctor will arrange for you to have a central line put in. A central line is a long, bendy plastic tube that delivers your drugs straight into one of the main blood vessels in your upper chest. There are several different types of central line, including PICC lines (peripherally inserted central catheters) and ports.

Some central lines go into the centre of your chest and run under your skin up to your collarbone. Here is a diagram, showing where the line goes.

PICC lines go into your arm, in a similar place to a normal drip. The line runs up inside the vein to your shoulder. 

Ports are small chambers, placed under your skin, that are connected to the rest of the central line tube inside your body. Your nurse puts a needle through the skin into the port each time you have chemotherapy. There is more about all these types of central lines in the main chemotherapy section of CancerHelp UK.

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. Or if you are prescribed them 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 of CancerHelp UK.

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.

There is a general section on chemotherapy in CancerHelp UK. It explains the treatment in detail including

• How chemotherapy works
• How chemotherapy is planned
• How chemotherapy is given
• General side effects
• Living with chemotherapy

If you would like more information about anything to do with chemotherapy, contact one of the chronic leukaemia organisations. They will be happy to help. They often have free fact sheets and booklets they can send you.

You can also contact our cancer information nurses. They would be happy to help.