Both cancer therapy and acute myeloid leukemia (AML) can sometimes produce side effects. For most patients, side effects are temporary and subside once the body adjusts to therapy or when therapy is completed. For other patients, side effects can be more severe, sometimes requiring hospitalization.
Before you undergo treatment, talk with your doctor about potential side effects. Drugs and other therapies can prevent or manage many side effects.
Common Side Effects
- Low blood cell counts. AML decreases the production of normal blood cells. In addition, chemotherapy is toxic to both normal blood cells and AML cells. The normal blood cells are eliminated from the marrow along with AML cells. For the patient, this results in a severe deficiency in
- Red cells (anemia)
- Platelets (thrombocytopenia)
- White cells called “neutrophils” and “monocytes” (neutropenia and monocytopenia).
Transfusion of red cells and platelets is almost always needed for a period of several weeks during treatment. After that, the blood cell counts usually return toward normal.
- Infection. During treatment for AML, the deficiency of neutrophils and monocytes (types of white cells) can lead to infection. The risk of infection may be increased because chemotherapy damages the lining of the mouth and intestines, making it easier for bacteria to enter the blood. When the white cell count is low and infection risk is increased, antibiotics are given to prevent or treat infection. Transfusion is not generally used for patients with a low neutrophil count, but can be used in patients with high fever, infection that is unresponsive to antibiotics, blood fungal infections or septic shock. Growth factors may be given to the patient to stimulate the marrow to make new white cells.
- Graft versus host disease. If you undergo an allogeneic stem cell transplantation, you're at high risk of developing graft versus host disease (GVHD). The older you are, the higher your risk for GVHD. GVHD develops when the donor's immune cells mistakenly attack the patient's normal cells. GVHD can be mild, moderate or severe - even life threatening.
- Kidney stones. Some AML patients may build up uric acid in their blood as a result of a very high white cell count. The use of chemotherapy may also increase uric acid, which is a chemical in the cell. Uric acid enters the blood and is excreted in the urine. If many cells are killed simultaneously by therapy, the amount of uric acid in the urine can be so high that kidney stones can form. This may seriously interfere with the flow of urine. Drugs such as allopurinol (Zyloprim®) or rasburicase (Elitek®) can be given to minimize the buildup of uric acid in the blood.
The following side effects are also common. Click here to read more about these side effects.
- Mouth ulcers
- Temporary hair loss
- Nausea and vomiting
Long-Term and Late Effects of Treatment
Treatment for individuals who have AML sometimes causes effects that continue after treatment ends (long-term effects) or develop much later in life (late effects). Various factors can influence the risk of developing long-term or late effects, including
- Type and duration of treatment
- Age at the time of treatment
- Gender and overall health.
Most AML patients are treated with an anthracycline, like daunorubicin. Anthracyclines have been associated with increased risk for heart muscle injury or chronic heart failure. Heart disease may not become apparent until many years after therapy ends. Stem cell transplantation is used to treat some patients with AML. It has been associated with long-term or late effects, including infertility, thyroid dysfunction, chronic fatigue and risk for developing a second cancer (lymphoma; melanoma of the skin; or cancer of the tongue and salivary glands, central nervous system, bone, soft tissue and thyroid gland). The number of patients who develop secondary cancers is small. These and other possible long-term and late effects can be managed.
For more information see the free The Leukemia & Lymphoma Society’s free publications:
- Long-Term and Late Effects of Treatment in Adults
- Long-Term and Late Effects of Treatment for Childhood Leukemia and Lymphoma Facts.
- Managing Side Effects
- Integrative Medicine and Complementary and Alternative Therapies
- Download lists of questions to ask your doctor
- Download or order The Leukemia & Lymphoma Society’s free booklet, Understanding Side Effects of Drug Therapy