Chemotherapy for Blood-Related Cancers

If you have a blood-related cancer, such as leukemia or lymphoma, chemotherapy is probably one of your treatment options.

How chemotherapy works

Chemotherapy uses drugs to destroy cancer cells or stop them from growing. The goal is to either slow down the disease or to bring it into remission (no more signs of disease).

Chemotherapy attacks cells that are growing and multiplying. Cancer cells are usually actively growing and multiplying, so chemotherapy attacks them. However, chemotherapy also attacks your body's healthy cells that are growing. This can cause side effects. After the chemotherapy is stopped, most of your body's healthy cells will grow normally again.

There are many kinds of chemotherapy drugs, and they work in different ways. Doctors choose the drug to use based on the type of cancer being treated. They often combine drugs, because they can work better together. For some diseases and some patients, chemotherapy can bring about long-term remission or even a cure. New drugs are always being developed. New drugs are tested in clinical trials.

Diseases treated with chemotherapy

Chemotherapy is a "systemic treatment." This means it can attack cells throughout the body. This is one reason chemotherapy is often used to treat blood-related cancers. In blood-related cancers, cancer cells are often spread throughout the body by the bloodstream. Chemotherapy is also used to treat other types of cancer.

For acute leukemias, chemotherapy may be divided into three stages: 

• Induction chemotherapy is the first step to reducing the number of cancer cells.
• Consolidation chemotherapy builds on the effect of induction treatment. The goal is to reach a complete remission of the cancer.
• Maintenance chemotherapy may be given after remission to prevent the cancer from coming back (relapse).

What to expect during chemotherapy

If you and your doctor decide to use chemotherapy, your doctor will create a plan for you. Your doctor will choose: 

• Which drug or combination of drugs to use
• A dose based on your size and age
• A treatment schedule

Chemotherapy is usually given in cycles. For example, you may have several days of chemotherapy followed by several days off. Sometimes your doctor plans the number of cycles ahead of time. Other times, your doctor may decide how many cycles you need based on blood tests, CAT scans or other tests that show how well the chemotherapy is working.

The drugs can be given in different ways. The most common are: 

• As a pill or liquid you swallow
• Through an IV into a vein

If you get chemotherapy through an IV, you may have a thin tube called a catheter surgically inserted into a larger vein in your chest, neck or arm. With a catheter in place you will not need to have a needle stick each time you get IV drugs.

Your care during chemotherapy

It is important that you take all your medications and follow your doctor's instructions. Some drugs will not work well if they are not taken at the right times or amounts. If you have a central line, you and your family members will be taught how to care for it. This care is important to help you avoid infections or other problems with the central line. You may also be given drugs to help prevent or reduce some of the side effects of chemotherapy.

One side effect of chemotherapy is that it attacks the cells in the bone marrow that produce blood cells for your body. This leads to low numbers of white blood cells, red blood cells and platelets while you are being treated. 

• Low numbers of white blood cells put you at risk for infection. Your doctor will tell you steps to take to avoid infections. You may also be given a growth factor — a drug that helps your body make more blood cells. A common white blood cell growth factor is filgrastim (Neupogen^®).
• Low numbers of red blood cells cause anemia. You may get red blood cell transfusions or a growth factor that helps your body make more red blood cells. This growth factor is called erythropoietin (Procrit^®, Epogen^®, Aransep^®).
• Low numbers of platelets can cause bruising and bleeding. If your platelet count is very low, you may get a platelet transfusion or a platelet growth factor called oprelvekin (Neumega^®).

Side effects

The goal of chemotherapy treatment is to destroy the cancer cells without hurting too many healthy cells. The damage to healthy cells causes side effects. The side effects you may have depend on the drugs and doses used for your treatment. Some common side effects include: 

• Hair loss
• Loss of hunger and loss of weight
• Sores in the mouth and throat
• Nausea and vomiting
• Constipation
• Diarrhea
• Tiredness (fatigue)
• Numbness of fingertips or toes caused by damage to the nervous system
• Damage to the heart, liver or kidneys
• Delays in growth and the ability to learn for some children
• Infertility
• Risk of getting another kind of cancer later

There are treatments that can help with some of these side effects. Many side effects go away after the chemotherapy is stopped, but some may last for a long time or are permanent.