Chronic myeloid leukaemia (CML) chemotherapy drugs and their side effects

You usually have chemotherapy as a series of cycles of treatment. You have the drugs over a few days or weeks. Then you have a break of a few weeks to allow your body to recover from the effects of the chemotherapy drugs. You repeat the cycle until you have had a full course of treatment. The number of cycles you have depends on

• Which drugs you are having
• How your CML is responding to treatment
• How your body is coping with the side effects

There are many different chemotherapy side effects, caused by different drugs. Not everyone gets every side effect with every drug. Some people react more than others. And different drugs have different side effects. So no one can tell you exactly what will happen to you. The side effects that tend to happen with all chemotherapy drugs are

• A drop in your blood cell counts, causing increased risk of infection, anaemia and risk of bleeding or bruising
• Tiredness
• Loss of fertility

The links above will take you to more information about these side effects. All the drugs will make your blood cell counts fall. This includes the red cells and platelets, as well as the white cells.

If you are concerned about not being able to have children after treatment, talk to your doctor. Some drugs are less likely to affect fertility. There may be other steps you can take. There is more information about fertility and chemotherapy in the chemotherapy section of CancerHelp UK. You should not become pregnant while on chemotherapy because many of the drugs can damage a developing baby.

These days, if you have early phase CML, you are more likely to have treatment with imatinib (Glivec) or interferon instead of chemotherapy. But some people have CML that doesn't respond to these treatments, or becomes resistant after a while. Your doctor may then suggest chemotherapy.

Hydroxycarbamide (which used to be called hydroxyurea) is the most commonly usedmay be used as chemotherapy for CML. This chemotherapy tablet causes relatively mild side effects. You will have an increased risk of infection and may feel sick, but this is usually quite mild. There is more on the specific side effects of hydroxycarbamide in the cancer drug section of CancerHelp UK.

Another drug used less often is called busulphan. Busulphan can cause a drop in blood cells, increasing your risk of infection. This may also cause abnormal bleeding (such as bad nosebleeds) and tiredness. Busulphan may also cause sickness and loss of appetite.

Some people have more intensive high dose chemotherapy for CML, followed by bone marrow or blood stem cells through a drip. You may hear this called a bone marrow transplant or stem cell transplant. A variety of different drugs and combinations of drugs can be used for this treatment. You can ask your doctor or clinical nurse specialist the names of the drugs that they will use for you.

High dose chemotherapy has more severe side effects than regular dose treatment. The doses given to you are high enough to kill your bone marrow cells, so you will have an increased risk of infection for some weeks after your treatment. You will be in hospital in a room of your own, to help protect you against infections. Sickness, diarrhoea, hair loss and a sore mouth can also be common side effects. There is more about bone marrow or stem cell transplant for CML in this section of CancerHelp UK.