Leukemia — Part 2
Chemotherapy
Chemotherapy is a term used for many different types of drugs that are
used to get rid of cancer cells. It is usually given in cycles: a treatment
period, then a recovery period, and then another treatment period; and
so on. Sometimes, the chemotherapy can be given in an outpatient clinic
setting, a doctor’s office, or even at home. Other types of drugs
are given in the hospital, and the person with leukemia will stay in the
hospital for a few days. Chemotherapy can be given in several different
ways:
- by mouth (orally) in the form of liquid or pills
- by injection directly into a vein (intravenously or IV)
- through a catheter (a thin, flexible tube) placed in a large vein,
often in the top part of the chest. Catheters stay in place for many months
or years, and are useful for patients who need a lot of IV treatments.
It prevents having to have a needle placed in the vein each time chemotherapy
or other medications are needed. Instead, the health care professional
can inject drugs into the catheter, preventing as much discomfort.
- in shots (subcutaneously)
- in the spinal fluid. This is called intrathecal medications. The
procedure that is used to give chemotherapy in the spinal fluid is called
a lumbar puncture. The child with leukemia is given medication to make
them sleepy and to help them not remember that they had a lumbar puncture.
Then, medication is injected directly into the spinal column. This helps
get rid of cancer cells that may be in the brain or the spinal fluid,
and that cannot be reached when medication goes through the veins. Another
way to give intrathecal (spinal) medication is through an Ommaya reservoir.
This is a special catheter that is placed, under the scalp, by the doctor
to allow anticancer drugs to be injected into the catheter.
Radiation therapy
Radiation therapy, also called radiotherapy, uses high-energy rays to
kill leukemia cells. A large machine directs radiation at the spleen,
the brain, or other parts of the body where leukemia cells have collected.
Some patients get total-body irradiation, which is radiation that is directed
to the whole body. This is usually given before a bone marrow transplant.
Radiation may be given at a hospital or at a clinic. Often, the patient
comes each day for several weeks to get a radiation treatment, and then
goes home.
Stem cell transplant
Some kids with leukemia have a stem cell transplant which allows them
to be treated with high doses of drugs, radiation, or both. These higher
doses may be more effective in destroying all of the leukemia cells in
the person’s body. However, it also destroys the normal cells in
the body, too. The patient receives healthy stem cells through a flexible
tube placed in a large vein in the neck or chest area. New blood cells
develop from the transplanted stem cells, replacing the leukemia cells.
The patient usually stays in the hospital for several weeks after the
transplant to avoid getting an infection until the transplanted stem cells
begin to produce enough white blood cells to fight off an infection. Kids
who have stem cell transplants must stay out of school for several months,
until their immune system can fight off infections.
There are several types of stem cell transplantation:
- Bone marrow transplantation. – Stem cells come from the
bone marrow.
- Peripheral stem cell transplantation – Stem cells come from
peripheral blood.
- Umbilical cord blood transplantation – for a child who does
not have a donor, the doctor may use stem cells from umbilical cord blood
from the umbilical cord when a new baby is born. This blood is very rich
and has often worked well for transplants.
Stem cells come from the patient or from a donor. A donor is another
person who has the same or similar type of bone marrow.
- Autologous stem cell transplantation – This type of transplant
uses the patient’s own stem cells. The stem cells are removed from
the patient and treated to kill any leukemia cells that are present. The
cells are then frozen and stored, to be given back to the person after
they have received high dose chemotherapy and radiation therapy.
- Allogeneic stem cell transplantation – This type of transplant
uses healthy stem cells from a donor. The patient’s brother, sister
or parent may be the donor, if they have compatible bone marrow. If not,
an unrelated donor is sought from a registry of potential bone marrow
donors across the continent.
- Syngeneic stem cell transplantation – If the person with
leukemia has an identical twin, syngeneic stem cells may be used for transplantation.
Other medications and supportive care - Due to the frequent infections
that people with leukemia may acquire, antibiotics and other drugs may
be given frequently. The doctors, nurses, and other members of the health
care team may advise the young person to stay away from football games,
grocery stores, the mall, and other places where there may be crowds and
people with colds and other contagious diseases. An infection should be
treated seriously, and medical attention should be sought immediately.
Patients may need to stay in the hospital for intravenous (IV) antibiotics
and other treatments.
Transfusions of red blood cells or platelets is another common for of
treatment during leukemia therapy. Red blood cells will give the patient
more energy, and platelets will reduce the risk of serious bleeding. Often,
these transfusions may take place in the doctors office or clinic, as
an outpatient.
Dental care is also very important during treatment for leukemia, as
chemotherapy and leukemia can make the mouth sensitive, easily infected
and likely to bleed. The doctor and dentist will help the patient and
parents understand how to take care of the mouth during treatment.
Possible treatment side effects
It is common for a person with leukemia to have side effects of treatment.
This is because cancer treatment often damages healthy cells and tissues
while ridding the person of leukemia cells. The type and severity of side
effects will depend on what chemotherapy medicines are given, what the
doses of those medications are, how much, if any, radiation is given,
and many more individual factors.
Chemotherapy side effects. The side effects of chemotherapy depend mainly
on the specific drugs and the doses in which they are prescribed. In general,
anticancer drugs affect cells that divide rapidly, especially leukemia
cells. The other rapidly dividing cells that may be affected by chemotherapy
include:
- Blood cells: These cells fight infection (white blood cells),
help blood clot (platelets), and carry oxygen to all parts of the body
(red blood cells). When these blood cells are affected, the child is likely
to get infections, bleed or bruise easily, and feel tired or weak. There
are medicines that can help bring counts up more quickly, or blood transfusions
may be given to help red blood cells and platelets recover.
- Hair root cells: Chemotherapy may cause the person to have partial
or complete hair loss. This is a temporary side effect, and the hair will
grow back when treatment is completed. However, the hair may be a different
color or texture than it was before chemotherapy treatments.
- Digestive tract cells: Mucositis is a term to describe sores that
may go from the mouth all the way through the other end of the digestive
tract (anus). In addition to mucositis, the person receiving chemotherapy
may experience nausea, vomiting, diarrhea, or a poor appetite. Many of
these side effects can be controlled with medications.
Radiation side effects. Side effects of radiation therapy vary from person
to person, and depend on the dose and site of the treatments. Some patients
may become very tired as the treatment continues, and it is important
to get enough rest during this time. The skin over the treatment area
may become red, dry and tender. The doctor, or radiation oncologist, may
suggest ways to treat the skin.
Stem cell transplantation. The risk of infection, bleeding and other
side effects increase with stem cell transplantation, due to the very
high doses of chemotherapy and radiation that are given. Graft-versus-host
disease (GVHD) may occur in children who receive stem cells from a donor’s
bone marrow. In GVHD, the donated stem cells react against the patient’s
tissues. The organs that are most often affected include the liver, skin,
or digestive tract. GVHD can be mild or severe, and can occur any time
after the transplant. Steroids or other drugs may help.
Part 2 — Chemotherapy, stem cell transplants, and possible side effects
For more information, please contact:
Kathy Davis, MSEd, PhD
kdavis2@kumc.edu
(913) 588-6305