Chemotherapy is a common treatment for almost all types of cancer, including leukemia, which is cancer of the blood and bone marrow. It uses potent drugs that damage or kill cancer cells. Chemotherapy is considered a systemic treatment because it travels through the body in the bloodstream to kill cancer cells all over the body.

Other treatment options can also be combined with chemotherapy to treat leukemia, including radiation therapy, stem cell transplantation, bone marrow transplant, monoclonal antibodies, and targeted therapies.

Phases of Chemotherapy Treatment

Chemotherapy treatment for acute leukemias typically consists of two to three phases, depending on the type of leukemia you have. These phases are induction, consolidation, and maintenance (post-consolidation). These phases are not used to treat chronic leukemias.

Induction

The first phase of chemotherapy is induction, which lasts around one week. Induction treatment is a short and intensive treatment used to kill leukemia cells in the blood (known as blasts) and to reduce the number of blasts in the bone marrow.

Consolidation

The second phase is consolidation, which begins after a person recovers from induction treatment. Consolidation is given over the course of many cycles to kill any remaining leukemia cells that survived induction therapy. After every cycle, there is a period of rest to give time for recovery.

Maintenance

Maintenance (or post-consolidation) continues treatment over the course of many months or years after the consolidation phase is finished. A low dose of chemotherapy is used to prevent cancer from recurring. This method is commonly used to treat acute promyelocytic leukemia (APL) and acute lymphoblastic leukemia (ALL), but is not often used for other types of leukemia.

Chemotherapy for Acute Myeloid Leukemia

Some of the common chemotherapy drugs used to treat acute myeloid leukemia (AML) include:

• Cerubidine (daunorubicin)
• Cytarabine
• Dacogen (decitabine)
• Idamycin (idarubicin)
• Vidaza (azacitidine)

People with FLT3 or other genetic mutations may be treated with Rydapt (midostaurin).

In rare cases of AML (around 3 percent), leukemia cells can spread to the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord. This is known as central nervous system (CNS) involvement. If you have CNS involvement, chemotherapy can be injected into your CSF in a method known as intrathecal chemotherapy. This chemotherapy is given through a lumbar puncture or a specialized catheter known as an Ommaya reservoir.

Chemotherapy for Acute Lymphoblastic Leukemia

Chemotherapy for ALL includes a combination of anticancer drugs, such as:

• Adriamycin (doxorubicin)
• Cerubidine (daunorubicin)
• Cytarabine
• Cytoxan (cyclophosphamide)
• Methotrexate
• Oncaspar (pegaspargase)
• Oncovin (vincristine)
• Prednisone

ALL can also have CNS involvement. Although CNS involvement is rare at the time of diagnosis, almost 50 percent of people with ALL later develop CNS leukemia. Intrathecal chemotherapy is given throughout ALL treatment to help prevent CNS involvement from developing.

Chemotherapy for Chronic Myeloid Leukemia

Chemotherapy used to be one of the main treatments for chronic myeloid leukemia (CML). However, it is rarely used now because another class of drugs — known as tyrosine kinase inhibitors (or TKIs) — is much better at treating CML.

Some examples of chemotherapy rarely used to treat CML include:

• Ara-C (cytarabine)
• Cytoxan (cyclophosphamide)
• Hydrea (hydroxyurea)
• Oncovin (vincristine)
• Synribo (omacetaxine)

Chemotherapy for Chronic Lymphocytic Leukemia

There are two main types of chemotherapy used to treat chronic lymphocytic leukemia (CLL): alkylating agents and purine analogs. Each type works differently to treat the disease by interfering with the leukemia cells’ growth. Additionally, corticosteroids are often used as part of chemotherapy treatment to relieve side effects.

Alkylating Agents

Alkylating agents work by damaging the DNA in cancer cells so they cannot divide. Chemotherapy affects all cells in the body, including normal cells that aren’t cancerous. In rare cases, alkylating agents can damage bone marrow cells and cause leukemia. The risk is highest five to 10 years after you have completed treatment.

Examples of alkylating agents used against CLL include:

• Cytoxan (cyclophosphamide)
• Leukeran (chlorambucil)
• Treanda (bendamustine)

Purine Analogs

Purine analogs belong to a larger class of chemotherapy drugs known as antimetabolites. These drugs are shaped like the building blocks needed to make DNA and RNA. When a cell tries using them, the DNA cannot be copied and the cell cannot grow and divide.

Examples of purine analogs used to treat CLL include:

• Fludara (fludarabine)
• Leustatin (cladribine)
• Nipent (pentostatin)

Fludara is typically one of the first treatments doctors will use against CLL. It can also be combined with another chemotherapy, Cytoxan, and a biologic, Rituxan (rituximab) in a combination called FCR (referring to the first letter of each drug).

Corticosteroids

Corticosteroids, or steroids, are drugs that mimic the body’s natural hormones. They are used as part of treatment for many types of cancer and other diseases, especially those affecting the immune system. Corticosteroids can help relieve nausea and vomiting associated with chemotherapy.

Examples of corticosteroids used as part of treating CLL include:

• Dexamethasone
• Methylprednisolone
• Prednisone

Chemotherapy Before a Transplant

Chemotherapy is also used to prepare the body for an allogeneic stem cell or bone marrow transplant. This use of chemotherapy is called conditioning, bone marrow preparation, pre-transplant treatment, or myeloablation. High-dose chemotherapy is used for a number of reasons before a transplant, including:

• Destroying any remaining cancer cells in the body
• Clearing out the bone marrow for the transplanted stem cells
• Suppressing the immune system so it does not attack the transplanted stem cells

Side Effects of Chemotherapy Treatment for Leukemia

Chemotherapy mainly affects cells in the body that divide quickly. This function helps the drug target cancer cells, but it also means hair follicles, cells in the bone marrow, and the lining of the mouth and intestines are also typically affected. Other side effects are also possible.

Common Side Effects

The side effects of chemotherapy depend on the type of medication you are given and how long you take it. Some common side effects may include:

• Hair loss
• Mouth sores
• Loss of appetite
• Low blood counts
• Nausea and vomiting

Tumor Lysis Syndrome

Tumor lysis syndrome can also develop in people with leukemia who are treated with chemotherapy. It is most common for those with large numbers of leukemia cells before treatment begins (bulky disease), and it often happens in the first cycle of chemotherapy.

When the leukemia cells are killed, they break open and their contents are released into the bloodstream. The kidneys try to filter this debris out of the blood, but there may be too much to process, causing excess minerals to build up in the blood. Tumor lysis syndrome can also lead to kidney failure and problems with the heart and nervous system.

Blood Cells and Chemotherapy

The bone marrow is responsible for creating new blood cells, and chemotherapy can damage and kill these cells during treatment. There are three different types of blood cells that can be damaged, leading to low levels in the blood.

• White blood cells, low levels of which can lead to increased risk of infections
• Red blood cells, low levels of which can lead to fatigue and shortness of breath
• Platelets, low levels of which can lead to bruising and bleeding

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia and their loved ones. Members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Have you or a loved one undergone chemotherapy? Share your experience in the comments below, or start a conversation by posting on MyLeukemiaTeam.