What Happens During Chemotherapy for CML

Chemotherapy is not a standard treatment for chronic myeloid leukemia (CML). If you get it, you meet with a medical oncologist before treatment starts. This doctor specializes in treating cancer with drugs. The doctor talks with you about your treatment and what you might expect.

Chemotherapy works by attacking cells at different stages in their reproduction cycle. The drugs target cells that divide quickly, such as leukemia cells. Since the drugs also attack other rapidly dividing cells, chemotherapy may affect healthy cells, too. And that means you may have side effects.

Not everyone with CML takes the same drug or takes it the same way. Your treatment is individualized for you. The treatment the doctor prescribes is based on these factors.

  • The kind of leukemia you have

  • The phase of the leukemia

  • Your general health

  • Your age

  • Concerns you have about side effects

  • The way you have responded to treatment in the past

  • Your doctor's familiarity with certain protocols

Which Drugs You May Take

For CML, the treatment your doctor prescribes is based on what phase you are in.

If you're in the chronic or accelerated phases, your doctor will likely give you Hydrea (hydroxyurea) or Ara-C (cytosine arabinoside).

If you're in the blast phase, your disease may resemble acute myeloid leukemia (AML) or acute lymphocytic leukemia (ALL). If it is like ALL, your leukemia may respond to these chemotherapy drugs used to treat ALL.

  • Oncovin or Vincasar (vincristine)

  • Adriamycin (doxorubicin)

  • Prednisone

If your leukemia resembles AML, your leukemia may respond to a combination of Ara-C (cytosine arabinoside) and an anthracycline such as Cerubidine or Daunomycin (daunorubicin) or Idamycin (idarubicin).

If the leukemia has spread to your brain or spine, your doctor may suggest Ara-C (cytarabine arabinoside). This is injected into your spinal canal to ease symptoms.

If you're in the relapse phase, the type of drugs you take is often influenced by the clinical trial you're part of.

Where and How You Take Chemotherapy

After evaluating your case, your doctor will decide these things.

  • The drug or a combination of drugs you'll take

  • How you will take the drugs

  • How long you should take them

Most people have chemotherapy as an outpatient at a hospital or clinic, at the doctor's office, or at home. Sometimes, though, depending on the drugs and on your health, you may need to stay in the hospital during treatment.

You may take chemotherapy in any of these ways.

  • Pill

  • Injection

  • Intravenous needle (IV)

  • A combination of the above

Sometimes the drugs are injected directly into your spinal fluid or brain to prevent cancer growth or to reach cancer cells that may hide there. This is called intrathecal chemotherapy or central nervous system (CNS) prophylaxis.

You receive chemotherapy in cycles over a period of time. That means you may take the drugs more than once, interspersed by periods without them. Having chemotherapy in cycles helps in many ways. It allows the drugs to kill more cancer cells because cells aren't all dividing at the same time. It allows your body to rest from the treatment, which damages quickly dividing normal cells, too, such as mucous membranes and bone marrow cells. It also gives you an emotional break between treatments. If your doctor doesn't tell you, you should ask how long this pattern will last. Knowing when it will end can make the routine easier to stay with.

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