Possible side effects of chemotherapy for acute myeloid leukaemia (AML) 1

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1 Possible side effects of chemotherapy for acute myeloid leukaemia (AML) 1 Possible side effects of chemotherapy for acute myeloid leukaemia (AML) This information is from the booklet Understanding acute myeloid leukaemia. You may find the full booklet helpful. We can send you a free copy see page 5. Contents Side effects of chemotherapy Sex during chemotherapy More information and support Side effects of chemotherapy Risk of infection Chemotherapy can reduce the number of white blood cells, which help fight infection. If the number of your white blood cells is low, you ll be more prone to infections. A low white blood cell count is called neutropenia. Always contact the hospital immediately on the 24-hour contact number you ve been given and speak to a nurse or doctor if: you develop a high temperature this may be over 37.5 C (99.5 F) or over 38 C (100.4 F) depending on the hospital s policy. Follow the advice that you have been given by your chemotherapy team you suddenly feel unwell, even with a normal temperature you feel shivery and shaky you have any symptoms of an infection such as a cold, sore throat, cough, passing urine frequently (urine infection), or diarrhoea.

2 Possible side effects of chemotherapy for acute myeloid leukaemia (AML) 2 If necessary, you ll be given antibiotics to treat any infection. You ll have a blood test before each cycle of chemotherapy to make sure your white blood cells have recovered. Occasionally, your treatment may need to be delayed if the number of your white blood cells is still low. While you re having chemotherapy it s best to avoid coming into contact with someone who may have an infection. This includes keeping away from large groups of people. You may also be told to be careful about what you eat in order to avoid infection from raw, undercooked or contaminated food. The hospital will tell you how to prepare foods and which foods to avoid. You may be given injections of a drug called G-CSF (granulocyte-colony stimulating factor). This is a type of protein that stimulates the bone marrow to produce more white blood cells. G-CSF may help reduce the length of time that your white blood cell count is low. The injections are given under the skin (subcutaneously). Anaemia (low level of red blood cells) If the level of red blood cells in your blood is low, you may become anaemic. This can make you feel tired and breathless. Anaemia can be treated with blood transfusions. Bruising and bleeding If the number of platelets in your blood is reduced you may bruise very easily, or bleed more than usual from minor cuts or grazes. Tell your hospital doctor or nurse about this and contact them straight away if you notice or have: nosebleeds bleeding gums tiny red or purple spots on the skin (petechiae) that sometimes cluster to make a rash. Ways to help you avoid injuries If your platelets are low you ll need to be careful to avoid injuries. Here are some things you can do at home to help you avoid any injuries: Wear protective gloves when doing anything around the house or gardening. Be careful to avoid bumping into things or tripping. Use a soft toothbrush to protect your gums from bleeding and don t floss. Some people may need a platelet transfusion. This is given by drip (infusion) as a day patient. The platelets will start working immediately to prevent bruising and bleeding. Tiredness (fatigue) Chemotherapy affects people in different ways. Tiredness can build up over a course of treatment. If you ve had a lot of chemotherapy or a combination of treatments, it can last for several months or more after your treatment has finished. Try to cut down on any unnecessary activities and ask your friends or family to help with jobs such as shopping and housework. Gentle exercise can sometimes help with the symptoms of fatigue.

3 Possible side effects of chemotherapy for acute myeloid leukaemia (AML) 3 Sore mouth Chemotherapy can cause mouth problems such as a sore mouth, mouth ulcers or infection. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Your chemotherapy nurse will explain how to look after your mouth to reduce the risk of problems. They can give you mouthwashes, medicines and gels to help. We can send you more information on mouth care during chemotherapy. Our booklet Eating problems and cancer has some useful tips on coping with eating problems. Feeling sick Some chemotherapy drugs can make you feel sick (nauseated) or possibly be sick (vomit). Your specialist will prescribe anti sickness (anti-emetic) drugs to prevent this. Let your doctor or nurse know if your anti-sickness drugs aren t helping, as there are several different types you can try. Losing your hair You usually lose all the hair on your head during intensive chemotherapy treatment for AML. Your eyelashes, eyebrows and other body hair may also thin or fall out. Hair usually starts to fall out within a few weeks of starting chemotherapy or, very occasionally, within a few days. It is almost always temporary and your hair will grow back over a few months once your treatment is over. It will be very fine at first and may be a slightly different colour or texture than before. Coping with hair loss If you will lose your hair during cancer treatment, there are ways you can prepare. Cutting hair short before chemotherapy starts can stop the weight of long hair pulling on the scalp, which can make hair fall out earlier. Wearing a hairnet, soft cap or turban at night stops your hair becoming tangled and helps to collect loose hair. There are lots of ways you can cover up if you choose to, using hats, caps, wigs, turbans, scarves, bandanas etc. Ask your hairdresser to cut and style your wig for you. Our booklet Coping with hair loss has more information. There s also a video on our website about Bengu, who had hair loss following treatment for leukaemia. You can watch it at macmillan.org.uk/hairloss

4 Possible side effects of chemotherapy for acute myeloid leukaemia (AML) 4 Sex during chemotherapy Having chemotherapy can affect your sex life, although not everyone finds this. Side effects such as tiredness, feeling sick or weak can reduce your sex drive and make having sex difficult. Chemotherapy shouldn t have a long-term effect on your sex life. The side effects will gradually wear off when your treatment is finished. Usually there s no medical reason to stop having sex during chemotherapy. But if you have low platelets or a low white blood cell count, you may be advised to avoid penetrative sex until your blood count improves. Protecting your partner It s not known if chemotherapy drugs pass into semen or vaginal fluids. Doctors usually advise you to use condoms for a few days after chemotherapy to protect your partner. Remember that leukaemia can t be passed on to your partner and sex won t make leukaemia worse. Contraception It s not advisable to become pregnant or father a child while having any of the chemotherapy drugs used to treat leukaemia as they may harm the developing baby. It is important to use effective contraception during your treatment and for up to a year afterwards. You can discuss this with your doctor or specialist nurse. Chemotherapy affects people in different ways. Some people find they feel quite well at times during their treatment, but most find they become tired and have to take things more slowly. Do as much as you feel like doing and try not to overdo it. Always tell your doctor or nurse about the side effects you have. They can often prescribe medicines to improve them or change any medicines you re already taking to more effective ones. We can send you more detailed information about all the side effects mentioned in this section.

5 Possible side effects of chemotherapy for acute myeloid leukaemia (AML) 5 More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. Visit macmillan.org.uk or call us on , Monday to Friday, 9am to 8pm. You can order a copy of Understanding acute myeloid leukaemia, or any other cancer information, from be.macmillan.org.uk or by calling us. Hard of hearing? Use textphone , or Text Relay. Speak another language? We have telephone interpreters. We provide information in a range of languages and formats. Visit macmillan.org.uk/otherformats or call us. We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ Revised in November, Next planned review in 2018.