Side Effects

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. The side effects of chemotherapy may vary, depending on the drugs used and the overall health of the patient. 

Before you undergo treatment, talk with your doctor about potential side effects. Drugs and other therapies can prevent or manage many side effects.

Side Effects and Complications

  • 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).

Patients may need red blood cell and platelet  transfusions for a period of several weeks during treatment. After that, blood cell counts usually return to 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. White blood cell transfusions are not generally used for patients with a low neutrophil count. 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.
  • Tumor Lysis Syndrome. Tumor lysis syndrome is another potential side effect of chemotherapy. It can occur in patients who have large numbers of leukemic cells in their body during the induction phase of  chemotherapy. As the leukemia cells die, they break apart and release their contents into the blood. This causes a change in certain blood chemicals that may damage the kidneys and other organs. Tumor lysis can be prevented by giving the patient extra fluids to increase urination to flush the body of these substances. A medication called allopurinol (Zyloprim®) may be given to decrease levels of uric acid during treatment. The medication rasburicase (Elitek®) should be considered as initial treatment in patients with rapidly increasing blast counts, high uric acid levels or evidence of impaired kidney function.
  • Differentiation Syndrome. This is a potentially life-threatening complication of treatment with differentiating agents, such as all-trans retinoic acid (ATRA), enasidenib (Idhifa®) and ivosidenib (Tibsovo®). Symptoms include fever, swelling in the limbs and trouble breathing. Patients may also experience a drop in blood pressure and have fluid buildup around the lungs or heart. Treatment must begin at the first signs or symptoms. Treatment consists of steroid therapy or the administration of the antimetabolite drug hydroxyurea.

The following side effects are also common. Click here to read more about these side effects.

  • Mouth ulcers
  • Diarrhea
  • Temporary hair loss
  • Rashes
  • Nausea and vomiting
  • Fatigue

Fertility

Chemotherapy may also affect fertility (the ability to have a child in the future). Patients concerned about this potential side effect should talk with a fertility specialist before beginning treatment. Click here to learn more about fertility. 

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.

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