Side effects of CML treatment
When to contact your doctor or hospital
As a general rule, while you are having treatment you will need to contact your doctor or hospital immediately if you have any of the following:
- a temperature of 38oC or over (even if it returns to normal) and/or an episode of uncontrolled shivering (a rigor)
- bleeding or bruising, for example blood in your urine, faeces, sputum, bleeding gums or a persistent nose bleed
- nausea or vomiting that prevents you from eating or drinking or taking your normal medications
- severe diarrhoea, stomach cramps or constipation
- coughing or shortness of breath
- a new rash, reddening of the skin, itching
- a persistent headache
- a new pain or soreness anywhere
- if you cut or otherwise injure yourself
- if you notice pain, swelling, redness or pus anywhere on your body.
What are the side effects of CML treatment?
All treatments can cause side effects. However, the type and severity will vary between individuals, depending on the type of treatment used and how an individual responds to it. In general, more intensive treatment is associated with more severe side effects. It is important to report any symptoms you are having to your doctor or nurse. In most cases they can be treated and are reversible.
Chemotherapy kills cells that multiply quickly, such as leukaemic cells. It also causes damage to fast-growing normal cells, including hair cells and cells that make up the tissues in your mouth, gut and bone marrow. The side effects of chemotherapy occur as a result of this damage. These can include:
- the bone marrow’s ability to produce adequate numbers of blood cells. As a result, your blood count (the number of white cells, platelets and red cells circulating in your blood) will generally fall within a week of treatment.
- an increased risk of infection. Neutrophils are important white blood cells that help us to fight infection. While your white blood cell count is low you should take sensible precautions to help prevent infection.
- nausea and vomiting. You will be given anti-sickness drugs before and for a few days after your chemotherapy treatment. Be sure to tell the nurses and doctors if the drugs are not working for you and you still feel sick.
- changes to your sense of taste and smell. This is usually temporary but in some cases it lasts up to several months.
- mucositis, or inflammation of the lining of the mouth, throat or gut is a common and uncomfortable side-effect of chemotherapy and some forms of radiotherapy
- some damage to the lining of your bowel wall. This can lead to cramping, wind, abdominal swelling, constipation and diarrhoea. Be sure to tell the nurses and doctors if you experience any of these symptoms.
- hair loss is unfortunately a very common side effect of chemotherapy. It is, however, usually only temporary.
- tiredness in the days and weeks following chemotherapy
- some types of chemotherapy may cause a temporary or permanent reduction in your fertility. It is very important that you discuss any questions or concerns you might have regarding your future fertility with your doctor.
Tyrosine kinase inhibitiors (TKIs)
It is very important that you take your TKI as prescribed and not make any changes to your treatment without discussing it first with your haematologist. If there is not enough of the drug in your body, it is possible that the CML cells may become resistant to the treatment. Remember no two people are the same. In helping to make the best treatment decision about any side effects you may experience, your doctor will consider the specific details of your situation. Side effects associated with TKI treatment can include:
- nausea, vomiting and heartburn. Anti nausea drugs are available if needed. Changing when and how you take your TKI may reduce the symptoms.
- swelling, excessive watery eyes or dry eyes as well as bleeding in the whites of the eyes
- fluid retention in the hands, feet, and legs and occasionally around the heart and lungs can occur. Discuss these symptoms with your treating doctor and avoid salty foods to help reduce the swelling.
- your digestion of food can be affected and diarrhoea and constipation can occur. Increase your fluid intake and discuss these symptoms with your doctor.
- muscle, joint and bone pain can occur but it usually resolves within days to weeks. Drugs may be available to treat these symptoms after discussing it with your doctor. Muscle cramps can also occur.
- skin problems including rash, dry and itchy skin, sun sensitivity and tears and abrasions are a potential side effect of TKIs. A good skin care regime with moisturisers, non soap based cleansers, sunscreen and occasionally steroid-based cream can reduce the severity of these symptoms.
- people can experience a degree of tiredness or fatigue while having TKI treatment
- it is important not to become pregnant while on TKIs as it may affect the development of the growing baby. If you are considering having a baby, discuss your options with your treating doctor.
- bleeding can occur and it is important you notify your doctor or dentist that you are taking TKIs before having any procedure or operation
- people taking TKIs who have a history of diabetes or cholesterol problems may notice a change in their conditions. Make sure you discuss your complete medical history with your treating doctor and also notify them of any changes in your health so they can modify your treatment as needed.
- chest pain, stroke-like symptoms or shortness of breath are symptoms requiring immediate medical attention. Contact your doctor, and if you have a delay in contacting your doctor or feel quite concerned call an ambulance.
More information about CML