Treatment for chronic myeloid leukemia (CML) involves taking different medications and undergoing other therapies that may produce some unpleasant side effects. The good news is that most people can manage their side effects without having to stop treatment.
Treatments for CML
Oral medications called tyrosine kinase inhibitors, or TKIs, are a popular option for people in the chronic stage of myeloid leukemia. These medications block the protein tyrosine kinase from growing and multiplying the cancer cells. This treatment is quite effective, and most people who take TKIs eventually go into remission.
Available TKIs include:
- imatinib (Gleevec)
- dasatinib (Sprycel)
- nilotinib (Tasigna)
- bosutinib (Bosulif)
- ponatinib (Iclusig)
Along with drugs, you may have chemotherapy treatments. Chemotherapy is taken by mouth or in your veins. It works by killing cells that multiply quickly. While this treatment can kill leukemia cells, it may also kill off other fast-growing cells, like those that make your hair or the tissues in your mouth and in your gut, among others.
Common side effects
Side effects of CML treatment include:
- cardiac issues, like irregular heartbeat and congestive heart failure
- hair loss
- rash or other skin issues
- mouth sores
It’s important for you to report any changes in your health to your doctor. That said, some side effects may be unavoidable. Your doctor can help you identify lifestyle changes and other ways to cope with side effects. Keeping the line of communication open will also help you identify what’s a normal side effect and what might need more medical attention.
Ways to cope
Here are a few tips for managing the different side effects of CML treatment.
You may have the sensation that your heart is racing or is skipping beats while taking TKIs like Gleevec. These drugs can affect your heart’s rhythm, but it’s important to understand that this isn’t a primary side effect. You should bring this issue up to your doctor before trying to treat it at home.
If you have heart issues, like arrhythmia, before treatment, be sure your doctor knows as well. You may want to have an EKG before beginning your medication and follow-ups to monitor any heart changes during treatment.
Extreme tiredness or fatigue is something you may experience while in treatment for CML. It’s also a common symptom among those being treated for cancer in general. Get rest when you can. Light exercise, like walking, swimming, and cycling, and staying hydrated may also help with your fatigue.
Sometimes your tiredness may be worsened by anemia and low red blood cell counts. Your doctor can test your blood to determine your levels and prescribe medications to treat the anemia and help with your fatigue.
You may feel nauseous or lose your appetite, especially during chemotherapy treatments. Not everyone will feel this way. Risk factors include:
- being a woman
- being younger than age 50
- having had morning sickness during pregnancy
- having a history of motion sickness
- not drinking very much alcohol in the past
Ask your doctor to prescribe certain antinausea medications. Ondansetron (Zofran), alprazolam (Xanax), and metoclopramide (Reglan) are just a few that may help.
In addition to medication, eating small meals of foods that appeal to you is another thing you can do to help combat nausea. While you’re at it, make sure you’re drinking plenty of fluids and stay away from triggers like unpleasant smells.
Meditation and deep breathing are other things you can do to help relax your body and combat nausea.
Chemotherapy may kill the healthy cells that help grow your hair. You may lose hair all over your body — your eyelashes, armpit hair, pubic hair, etc. — not just on your head. In fact, both men and women share that losing their hair is one of the side effects related to cancer that they fear most.
There’s little you can do about this side effect. You may start to lose your hair about two to four weeks into treatment. Hair loss is usually temporary and should start growing back about three to six months after you’ve completed your chemo. When it grows back, it may be a different color or texture.
Doctors are exploring potential ways to prevent hair loss, though they haven’t been extremely effective. These include:
- Cryotherapy: In this treatment, you place ice packs on your head to slow blood flow to your scalp. Some people have had success with this method, but it may carry a risk of cancer recurring in the areas treated with the ice packs.
- Rogaine: This drug doesn’t stop hair loss, but it may help your hair return faster after treatment.
The best way you can deal with this side effect is to try to make yourself comfortable with your appearance and foster a good body image while you’re in treatment.
Diarrhea is one of the most common side effects of TKI drugs. Chemotherapy can also kill the cells in your intestines and lead to diarrhea. Beyond that, the stress and anxiety of going through cancer treatment can upset your stomach from time to time.
Diarrhea is a side effect worth mentioning to your doctor, especially if you experience any of the following symptoms:
- six or more loose stools in a day for two days or more
- blood in your diarrhea
- inability to urinate for 12 hours or longer
- inability to keep down liquids like water
- weight loss
- constipation in combination with diarrhea
- swollen abdomen
- fever over 100.4˚F (38˚C)
If you have diarrhea, make sure you’re drinking lots of water and other liquids. One of the main concerns is with dehydration.
As well, stick to low-fiber foods. For example:
Stay away from other foods that may irritate your intestines, such as:
- dairy products
- spicy foods
- caffeinated beverages
- prune juice
- foods high in fat and fiber
Probiotics may help. You can find these gut-healthy microorganisms in foods like yogurt or in dietary supplements. This bacteria aids in restoring your normal digestion. Some names you may encounter include Lactobacillus or Bifidobacterium. Your doctor may be able to suggest certain probiotic supplements.
Another side effect linked to TKIs is depression. You may also experience feelings of depression related to your cancer in general, and the drugs could make it worse. It’s important to tell a loved one and your doctor if you’re having these feelings, especially if they continue for two weeks or longer.
Engaging in regular exercise can help with your depression. So can seeking counseling to talk about your cancer and your feelings. Surrounding yourself with a network of supportive people may also help. Your doctor can refer you to different support groups in your area. Talking to people who are going through similar issues is invaluable.
It’s important to remember that your feelings are valid. Going through cancer treatment is tough. What isn’t necessarily normal is being unable to eat or sleep, feeling restless or confused, having trouble breathing, or having your feelings interfere with your daily life. Let your doctor know about these feelings, and call 911 if you have thoughts of suicide.
Rashes and other skin issues
TKIs may cause rashes and other skin issues like mouth sores. Up to 90 out of 100 people taking TKIs experience this side effect. Your skin issues may start around two weeks into your treatment. Let your doctor know if you experience this side effect, because early treatment is the key to keeping it under control.
Your doctor may prescribe hydrocortisone cream, tetracycline, or oral minocycline (Minocin). While these drugs may not stop your rash from occurring, they can help slow the development of your skin issues and lessen the severity.
You may also want to consider wearing sunscreen to protect your skin from UV light, which can make your rash worse. Read labels carefully and try choosing sunscreens that don’t contain irritating alcohol. Wearing clothing with long sleeves or legs is another option.
As well, pick up mild soaps and detergents, skip hot showers, and choose hypoallergenic makeup whenever possible.
Another common side effect of TKI therapy is mouth sores. Your doctor can prescribe what is commonly known as “magic mouthwash” to help with this side effect. You would use it every four to six hours and avoid eating or drinking for 30 minutes after using it.
Other things you can do:
- Brush and floss regularly.
- Skip spicy foods and hot foods and drinks.
- Eat soft foods.
- Use milder toothpaste or simply use baking soda to brush your teeth.
- Rinse your mouth with saline several times per day.
When to see your doctor
You don’t need to suffer with side effects. Contact your doctor to explain what you’re experiencing and to see how your medical team might be able to help you. There are different medications that can help relieve certain issues, for example. Your doctor may even be able to uncover aspects of your lifestyle — diet, exercise, etc. — that might be making your side effects worse.
It’s also a good idea to contact your doctor if you notice anything unusual or if a side effect is deeply affecting your everyday life. Contact your doctor if you experience any of these symptoms:
- fever over 100.4˚F (38˚C) or uncontrolled shivering
- unusual bleeding or bruising, like blood in your urine or a nose bleed
- nausea or vomiting that keeps you from taking your medications or eating and drinking
- severe stomach issues, like diarrhea, cramping, or constipation
- shortness of breath and coughing
- new rash or itching
- headache that won’t let up
- pain or soreness, swelling, or pus anywhere on your body
- episodes of self-injury
The takeaway: Getting support during treatment
You can still enjoy a good quality of life while in treatment for CML. Just keep in communication with your doctor about the side effects you’re experiencing to see if there’s anything your medical team can do to help. Otherwise, follow the techniques described previously to help yourself cope at home. Your best shot at beating cancer is keeping up with your treatments, so try not to let side effects get you down.