Leukaemia

Infections and other treatment complications

Infections
Chemotherapy for leukaemia damages blood cells. White blood cells are needed to fight infection, so a shortage of white blood cells (neutropenia) makes people vulnerable to infection. The blood cell count is usually lowest from 7 – 14 days after chemotherapy but this varies with the drugs used. The blood count gradually returns to normal as the bone marrow recovers but some people have blood transfusions or growth factor injections to boost recovery (see ‘Supportive treatments’).

Any patient who is being treated with chemotherapy is at risk of infection. The risk depends on the type of chemotherapy being given. However, any illness, with or without a raised temperature, in patients treated with chemotherapy should be taken seriously and medical assistance obtained.

Infections were common during intensive chemotherapy or after high dose treatment given before a stem cell transplant. For one man it followed treatment with MabCampath, a biological therapy. Types of infection included influenza, pneumonia, septicaemia (infection of the blood), shingles, Clostridium difficile (C.diff), a fungal infection of the lungs and an abscess on the leg. Symptoms were: breathlessness and chest or back pain (pneumonia), diarrhoea (C.diff), rash (shingles), fever with ‘rigors’ (a kind of intense shivering), nausea, vomiting, and just feeling ‘not quite right’.
The severity of the infection varied. Some people didn’t feel particularly ill and only spent a few days in hospital having antibiotics. Others felt completely wiped out and were laid low for several weeks. Some feared they might die. Claire said she felt a sense of panic among the professionals around her; her best friend sought reassurance from a nurse but got none. Neil’s wife stayed overnight in the hospital once when he had septicaemia. When Brian had diarrhoea from C.diff. He lost his appetite and two stone in weight. He had to be moved out of his hospital room so it could be thoroughly cleaned.
Many people received their chemotherapy and other treatments intravenously through a central line (e.g. Hickman line) to avoid repeated needle punctures. Despite frequent and thorough cleaning, by staff or patients themselves, central lines were a common source of infection and often had to be taken out.
Some people were in hospital when they developed an infection; others had been discharged home either for a break between courses of treatment or after treatment had finished. Raised temperature is an important sign of infection, so those who were at home had been advised to monitor their temperature daily and to return to the hospital if it exceeded 38ºC (100.5ºF).
Getting infected meant having to stay in hospital for longer than planned or having to return to hospital. The next course of chemotherapy or other treatment was often delayed until after the infection had gone. Most infections were treated with antibiotics, often intravenously. Thelma was also given oxygen when she had pneumonia. Claire had to travel an hour and a half each way, every other day, to another hospital for injections of an anti-fungal drug for her lung infection.

After successful treatment for an infection, some people were given antibiotics to prevent future infections or to take at the first sign of infection to avoid treatment delays. One man’s dose of preventive antibiotics was increased after a bout of shingles.

Oral chemotherapy for chronic lymphocytic leukaemia (CLL) is relatively mild, and less likely to lead to infections. However, people with CLL or myelodysplastic syndrome (MDS) who are on ‘watch and wait’ may be at increased risk of infection because of the condition itself, in which the white cells may be defective. Several people had taken precautions, such as limiting their contact with people who had colds, by restricting their social life, avoiding public places, and cleaning their hands with alcohol gel after contact with others. These precautions, whilst sensible, should be balanced against the need to maintain as much of a normal lifestyle as possible.
Other treatment complications
Another common complication of leukaemia treatment is damage to egg or sperm production, causing infertility. This is described in detail in ‘Treatment-induced infertility’. Some people who had received a donor stem cell transplant later developed a complication called graft-versus-host-disease (GVHD) involving a skin rash, diarrhoea and vomiting, or jaundice (see ‘Remission and recovery from treatment’).

Various other less common problems occurred among the people we spoke to. Some had allergic or other types of adverse reactions to particular drugs, such as biological therapies, anti-sickness drugs, immunoglobulin treatment, blood thinners, and a preservative added to harvested stem cells before freezing. Others developed a blood clot or deep vein thrombosis (DVT) as a result of inactivity in hospital and were treated with blood thinners such as heparin, clexane or warfarin. A few people had a serious bleed during treatment while they had very few platelets in their blood, which are essential for clotting. One woman developed piles which had to be removed surgically. As a result of having multiple blood transfusions, Elsa ended up with too much haemoglobin, requiring further drug treatment. A few people developed diabetes, jaundice or cataracts as a result of treatment.
Last reviewed: August 2015.
Last updated: August 2015.

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