Leukemia--Chronic Myeloid (Myelogenous)

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Treating Leukemia - Chronic Myeloid (CML) TOPICS

Chemotherapy for chronic myeloid leukemia

Chemotherapy (chemo) is the use of anti-cancer drugs that are injected into a vein or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this type of treatment useful for cancers such as leukemia that spread throughout the body. Any drug used to treat cancer (including tyrosine kinase inhibitors) can be considered chemo, but in this document the term chemo is used to mean treatment with conventional cytotoxic drugs that mainly kill cells that are growing and dividing rapidly.

Chemo was once one of the main treatments for patients with chronic myeloid leukemia (CML), but it is used much less often now that the tyrosine kinase inhibitors (TKIs) like imatinib (Gleevec) are available. Now, chemo may be used to treat CML when the TKIs have stopped working. It is also used as part of the treatment during a stem cell transplant.

The chemo drug hydroxyurea (Hydrea®) is taken as a pill, and can help lower very high white blood cell counts and shrink an enlarged spleen. Other drugs sometimes used include cytarabine (Ara-C), busulfan, cyclophosphamide (Cytoxan®), and vincristine (Oncovin®).

Omacetaxine (Synribo®) is a chemo drug that was approved to treat CML that is resistant to some of the TKIs now in use. It can help some patients whose CML has developed the T315I mutation that keeps most TKIs from working (discussed in the section about targeted therapy).

If you’d like more information on a drug used in your treatment or a specific drug mentioned in this section, see our Guide to Cancer Drugs , or call us with the names of the medicines you’re taking.

Side effects of chemotherapy

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

Possible side effects depend on the type and dose of drugs given and the length of time they are taken. Some common side effects of chemotherapy include:

  • Hair loss
  • Mouth sores
  • Loss of appetite
  • Nausea and vomiting
  • Increased risk of infection (from low white blood cell counts)
  • Easy bruising or bleeding (from low blood platelet counts)
  • Fatigue (from low red blood cell counts)

Still, different drugs can have different side effects. For example, vincristine can cause nerve damage (neuropathy) leading to numbness, tingling, or even pain or weakness in the hands or feet. Lung damage from busulfan is rare, but can be severe. Before starting treatment, speak with your health care team about the drugs you will receive and their possible side effects. Most side effects last a short time and go away once treatment is finished, but some can be permanent.

While getting treatment, be sure to tell your cancer care team about any side effects you have because there may be ways to lessen them. For example, drugs can be given to prevent or reduce nausea and vomiting.

Drugs known as growth factors, G-CSF (Neupogen®) and GM-CSF (Leukine®), for example, are sometimes given to increase the white blood cell counts and thus reduce the chance of infection. If your white blood cell counts are very low during treatment, you can also reduce your risk of infection by avoiding exposure to germs. During this time, your doctor may advise you to:

  • Wash your hands often.
  • Avoid fresh flowers and plants because they can 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 offers some protection in these situations).

You might also be given antibiotics before there are signs of infection or at the earliest sign that an infection may be developing. For more information on infections and how to avoid them, see our document Infections in People With Cancer.

If your platelet counts are low, you may be given drugs or platelet transfusions to help protect against bleeding. Likewise, shortness of breath and extreme fatigue caused by low red blood cell counts may be treated with drugs or with red blood cell transfusions.

For more general information about chemotherapy, please see our document, Understanding Chemotherapy: A Guide for Patients and Families.

Last Medical Review: 09/23/2013
Last Revised: 02/10/2014