Leukaemia

Supportive treatments

In addition to treatments aimed at destroying cancer, such as chemotherapy, radiotherapy, biological therapies and stem cell transplants, people with cancer may be given other treatments to help deal with the debilitating effects of the illness or its treatment.

Leukapheresis
Some people with chronic myeloid leukaemia (CML) had excess white blood cells removed before starting treatment by being connected to a cell separator machine that collects blood from one arm, removes the unwanted cells, and returns the remaining blood via the other arm. This is known as leukapheresis.

Steroids
Corticosteroids are a key part of some chemotherapy regimens. They can help to destroy cancer cells and make chemotherapy more effective, reduce allergic reactions or nausea, and often improve appetite. Kerry had steroids before any other treatment. A man with chronic lymphocytic leukaemia (CLL) had them to try to shrink his swollen lymph nodes before having chemotherapy; another had them after his red blood cells broke down (haemolysis) as a complication of CLL.

Some people were given steroids to build them up and boost their appetite when they didn’t feel like eating after treatment. Weight gain was common as a result and Marie said it might have contributed to the diabetes she developed. The second time she took steroids she controlled her weight through diet. Steroids also made her more energetic so she decorated every room in the house. Frances hated taking steroids because of the large number of pills involved.

Blood transfusions
Transfusions of red cells or platelets, are often given to people with leukaemia or myelodysplastic syndrome (MDS) because both the illness and chemotherapy can damage normal blood cell production causing shortages of red cells (anaemia), white cells (neutropenia), or platelets. It is possible to give transfusions of white blood cells (granulocytes) but there is little evidence that they are effective so they are not commonly used.

Transfusions are given from a drip into a vein in the arm or via a central line. More than one bag of blood or platelets is often given, so a transfusion could take several hours or require an overnight stay. When Neil was an inpatient he refused a third bag of blood late at night because he didn’t want to stay awake; the blood was wasted. Frances thought nothing of having transfusions as an inpatient, but to attend hospital only for a transfusion took ages and was frustrating. Marie found it boring but enjoyed chatting with the nurses and other patients; Jean felt stiff from sitting for such a long time. Neil got into trouble with the nurses when  he went with his drip stand to the hospital canteen during a transfusion. Transfusions of red blood cells can rapidly make a huge difference to people’s symptoms of anaemia.

Brian needed a transfusion because his white cell count dropped when his MDS (myelodysplastic syndrome) transformed into acute leukaemia. While on watch and wait for her CLL Jean became so anaemic that it caused chest pains; she was hospitalised, given a transfusion and started on chemotherapy. A man whose red cells broke down (haemolysed) as a complication of CLL was given blood transfusions but the new cells also haemolysed. Elsa had blood transfusions as the main treatment for her MDS.

Other people had transfusions after chemotherapy lowered their blood counts. Marie needed fortnightly transfusions alongside oral chemotherapy because it made her anaemic. Several needed frequent platelet transfusions because of severe bruising or bleeding. Two people were given irradiated blood after standard transfusions hadn’t worked; irradiating blood protects against rare complications of transfusions. Elizabeth had an infusion of lymphocytes from a donor as a boost after her stem cell transplant.

Blood cell production
Another way of correcting shortages of blood cells caused by leukaemia or its treatment is to stimulate the bone marrow to produce more. A growth factor called G-CSF (granulocyte-colony stimulating factor) can stimulate white cell production; a protein called erythropoietin (EPO) can make red cells. Both are injected under the skin (subcutaneously) in the thigh or abdomen. Elsa had both drugs regularly alongside blood transfusions for her MDS. Despite her fear of needles she chose to inject them herself to avoid daily visits from a nurse. Glyn’s first G-CSF injection was supervised by a district nurse, after that he managed it alone.

Antibiotics
A shortage of white blood cells (neutropenia) caused by leukaemia or its treatment increases the risk of catching life-threatening infections. Several people had been prescribed antibiotics to take routinely to prevent infections or were given a supply to take at the first sign of infection to avoid delays in treatment. Janet had been hospitalised previously for pneumonia that needed several courses of intravenous antibiotics and now has a supply of oral antibiotics to take when needed. A man who had been taking preventive antibiotics since completing treatment for acute myeloid leukaemia (AML) had the dose increased after contracting shingles.

Managing other side effects of treatments
Treatment side effects are discussed in detail in ‘Unwanted effects of treatments’ and many can be effectively managed medically. For instance, everybody receiving chemotherapy was given medication to counter nausea and vomiting. Damage to the lining of the mouth and gut (mucositis) was managed with mouth washes and painkillers such as morphine. Ann continues to take antacids long after her treatment. Glyn needed an anti-fungal gargle and gout tablets after treatment with alemtuzumab (MabCampath).

Other treatments
A number of treatments may be offered as part of supportive care in addition to those mentioned above. These may vary from person to person depending on individual need. Two women were put on the contraceptive pill to reduce heavy menstrual bleeding; another had a hysterectomy. One was given HRT because treatment had brought on an early menopause (see ‘Infections and other treatment complications’). Before her diagnosis Kerry had fluid drained from one of her lungs that was making her breathless. Ian's leukaemia had caused kidney failure and he needed dialysis for a while after diagnosis. He was advised to have his dental caries filled before having total body irradiation as it can worsen tooth decay. A few people became so ill that they spent a period in intensive care and had to learn to walk again afterwards.

Last reviewed: August 2015.

Last updated: August 2015.

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