Progress in the treatment of blood cancers has led to an increased understanding of which treatment is right for each patient. Chemotherapy is a common treatment for blood cancers, which you may receive with other treatments or with a transplant.
Below you will find information on possible treatments for blood-related cancers. For specific information on treatment options for your disease, visit Learning about your disease. Discuss these treatment options with your health care team and decide what treatment is best for you.
Chemotherapy medicines destroy cancer cells or stop them from growing. The goal is to either slow the disease or to bring it into remission (no more signs of disease).
How chemotherapy works
Chemotherapy medicines attack cells that are growing and multiplying. Cancer cells are usually actively growing and multiplying, so chemotherapy damages those cells. However, chemotherapy also affects your body's healthy cells that are growing. After the chemotherapy is stopped healthy cells will repair the damage from the chemotherapy and grow normally again.
There are many kinds of chemotherapy medicines, and they work in different ways. Doctors choose which medicine(s) to use based on the type of cancer being treated. They often combine medicines, because they can work better together. For some diseases and some patients, chemotherapy can bring about long-term remission or even a cure. In some diseases, chemotherapy is used to control the disease before a patient has a transplant.
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, like leukemia. 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.
Chemotherapy used in transplant
In an autologous transplant, which uses the patient’s own blood-forming cells, high doses of chemotherapy are used to help kill any remaining cancer. This type of chemotherapy is given immediately before a transplant and is called the preparative or conditioning regimen.
In an allogeneic transplant, which uses cells from a family member, unrelated donor or cord blood unit, chemotherapy is also given as part of the preparative regimen. It is used to weaken the patient’s own immune system so that the donor’s cells can engraft (settle in the patient’s marrow and start making blood cells). When the disease being treated is cancer, the chemotherapy may also help to kill any remaining cancer cells. The new cells received in transplant help fight the disease and provide a new healthy immune system.
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 medicine or combination of medicines to use
- A dose based on your size and overall health
- A treatment schedule
Chemotherapy with transplant (preparative regimen) is typically given in the 2-10 days before the transplant. Chemotherapy outside of transplant 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, scans or other tests that show how well the chemotherapy is working.
The most common ways chemotherapy medicines are given include:
- 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 large vein in your chest, neck or arm, known as a central line. With a central line in place you will not need to have a needle stick each time you get IV medications or need blood tests.
Your care during chemotherapy
It is important that you take all your medications and follow your doctor's instructions. Some medicines will not work well if they are not taken at the right time or in the right amounts. You may also be given medicine to help prevent or reduce some of the side effects of chemotherapy. 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.
Side effects of chemotherapy
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 medicines and doses used for your treatment. Ask your doctor about what side effects you might experience.
Immunotherapy, a type of targeted therapy, uses antibodies— special proteins that are designed to attach to the surface of cancer cells—to mark cancer cells for the immune system to destroy.
How immunotherapy works
These antibodies are made in laboratories and are similar to the natural antibodies everyone makes to fight infection. But instead of fighting infection, these new antibodies are used to fight cancer. They attach to cancer cells and help your own body’s immune system kill the cancer cells.
Unlike chemotherapy, the antibodies are targeted or specific to the cancer cell. As a result, antibody treatments tend to be less toxic and have fewer side effects. Often, though, these are combined with chemotherapy, because the two work together to fight the disease.
Rituximab is an example of this type of medicine. There is not yet an antibody treatment for all blood cancers. You should discuss with your doctor if immunotherapy might be helpful for treating your disease.
Small molecule therapies
Small molecule therapies are medications that work from inside a cancer cell to disrupt how the cell works.
How small molecule therapies work
Research has led to new medications that block certain functions inside cancer cells. When the medication blocks important activity inside the cancer cell, the cancer cell stops growing and dies. These medicines are usually pills you swallow. They may not cure the disease, but can help keep the disease in remission, as long as the patient continues to take the medication. For some patients, their disease may become resistant to these medications, and then another medicine or a transplant would be needed.
Tyrosine kinase inhibitors (TKI) are a group of medicines that are good examples of small molecule therapy. One type of TKI is called imatinib. Imatinib is used to treat chronic myeloid leukemia (CML). Imatinib, and the related medicines dastinib, nilotinib, bosutinib, and ponatinib are all examples of TKIs. The side effects for these medications can vary depending on the specific medicine. You should ask your doctor if there are small molecule therapies available that might be helpful for treating your disease. This is a rapidly changing area of medicine. Some small molecular therapy medicines are considered experimental and may only be available through a clinical trial.