Chemotherapy for acute lymphocytic leukemia

Chemotherapy (chemo) is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. But most chemo drugs don't reach the area around the brain and spinal cord. That's why they may need to be put right into the cerebrospinal fluid to kill cancer cells in that area.

Chemo for acute lymphocytic leukemia (ALL) involves the use of several drugs given over a long period of time (often about 2 years). Doctors give chemo in cycles. A round of treatment is followed by a rest period to allow the body time to recover.

Side effects of chemo

While chemo drugs kill cancer cells, they can also damage normal cells. This happens because they target fast growing cells such as cancer cells, but in the process they also damage other fast growing cells.

The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. Common side effects might include:

• Hair loss
• Mouth sores
• Higher risk of infection (from low white blood cells)
• Easy bruising or bleeding (from low blood platelets)
• Tiredness (from low red blood cells)
• Loss of appetite
• Nausea
• Vomiting
• Diarrhea

The side effects usually go away after treatment ends. Be sure to talk to your doctor if you are having trouble with side effects because there are often ways to manage them during treatment. For example, there are drugs that can be taken along with the chemo to help prevent or reduce nausea and vomiting. Drugs called growth factors are sometimes given to keep blood counts higher and reduce the chance of infection.

If your white blood cell counts are very low during treatment, you can help reduce your risk of infection by avoiding germs. During this time, your doctor or nurse may tell you to:

• Wash your hands often.
• Avoid fresh, uncooked fruits and vegetables and other foods that might carry germs.
• Avoid fresh flowers and plants because they may carry mold.
• Make sure other people wash their hands when they come in contact with you.
• Avoid large crowds and people who are sick (wearing a surgical mask can help protect you).

During and after treatment, you might also get antibiotics or other drugs as added protection. If your platelet counts are low, you might get platelet transfusions to keep you from bleeding. Low red blood cell counts, causing shortness of breath and tiredness, can be treated with drugs or with blood transfusions.

Organs that could be damaged by chemo include the kidneys, liver, testicles, ovaries, brain, heart, and lungs. By watching you carefully, the doctor may be able to prevent many of these side effects. If serious side effects happen, the drugs may have to be reduced or stopped. Be sure to tell your doctor about any problems you have.

One of the most serious side effects of chemo for ALL is the increased risk of getting acute myelogenous leukemia (AML) later. Less often, people cured of leukemia may later get non-Hodgkin lymphoma or other cancers. Of course, the risk of getting these second cancers must be balanced against the clear need to treat a life-threatening disease such as leukemia with chemo.

Tumor lysis syndrome is a side effect caused by the rapid breakdown of large numbers of leukemia cells. This can sometimes happen when treatment is started, but it is not a concern later on (when there are fewer leukemia cells). When these cells die, they break open and release their contents into the bloodstream. This cell waste can affect the kidneys, heart, and nervous system. Giving extra fluids or certain drugs can help the body get rid of these substances.