Chemotherapy for chronic myelogenous leukemia
Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. It is sometimes used to treat chronic myelogenous leukemia (CML). Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.
Chemotherapy was once one of the main treatments for CML. It is used much less often now that targeted therapy drugs such as imatinib (Gleevec) are available.
Chemotherapy is given for different reasons. You may have chemotherapy:
- if targeted therapy stops working or causes severe side effects
- to prepare for stem cell transplant
- Chemotherapy may also be given to control the symptoms of and improve quality of life of people living withadvanced CML (called palliative chemotherapy).
Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have spread to other parts of the body through the blood. The chemotherapy drugs used to treat CML are given intravenously or by mouth.
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The most common chemotherapy drugs used to treat CML are:
- hydroxyurea (Hydrea)
- busulfan (Myleran [oral], Busulfex [intravenous])
- cytarabine (Cytosar, Ara-C)
- high-dose cytarabine (HDAC)
- daunorubicin (Cerubidine, daunomycin)
- doxorubicin (Adriamycin)
- thioguanine (Lanvis, 6-TG)
- vincristine (Oncovin)
Chemotherapy is sometimes used in combination with other drugs. The most common drug combination used to treat CML is cytarabine and interferon alfa (Intron A, Wellferon).
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Side effects can happen with any type of treatment for CML but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.
Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of chemotherapy will depend mainly on the type of drug or drug combination, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for CML are:
- low blood cell counts (called bone marrow suppression)
- nausea and vomiting
- loss of appetite
- sore mouth and throat
- hair loss
- diarrhea and constipation
- skin problems
- allergic reactions
- fertility problems
Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.
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American Cancer Society. Leukemia - Chronic Myeloid (Myelogenous). Atlanta, GA: 2013: http://www.cancer.org/acs/groups/cid/documents/webcontent/003112-pdf.pdf.
American Society of Clinical Oncology (ASCO). Leukemia - Chronic Myeloid - CML. Alexandria, VA.: American Society of Clinical Oncology (ASCO); 2014: http://www.cancer.net/cancer-types/leukemia-chronic-myeloid-cml/view-all.
Cancer Care Ontario. Drug Formulary. Toronto, ON: Cancer Care Ontario;
National Cancer Institute. Chronic Myelogenous Leukemia Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014: http://www.cancer.gov/cancertopics/pdq/treatment/CML/HealthProfessional.
O'Brien SG, Goldman JM . Diagnosis and treatment of chronic myeloid leukemia. Wiernik PH, Goldman JM, Dutcher JP & Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 5: pp. 45-62.