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Central Lines![centralline.jpg]](images/centralline.jpg "centralline.jpg]")
To make it easier to give the chemotherapy drugs and
to avoid having to give frequent injections, a
plastic tube (called a central line) is usually put
into a vein in the chest. The line is put in under a
general or local anaesthetic and, apart from a stiff
shoulder, which may last for a couple of days, the
tube should be completely painless. Once it is in
place, the central line is either stitched or taped
firmly to the chest to prevent it from being pulled
out of the vein. The drugs are given through the tube
directly into the bloodstream. The line can stay in
for many months. Blood tests can be taken from the
line and blood transfusions can also be given through
it.
PICC lines
Sometimes a PICC line can be used instead of a central
line. A thin tube is inserted into a vein in the crook
of the arm. This can remain in place for several
months.
Side effects
Side effects of chemotherapy for AML
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Increased risk of infection
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Anaemia
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Tiredness (fatigue)
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Increased risk of bleeding or bruising
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Feeling sick, and being sick
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Sore mouth
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Hair loss The above effects are all short-term.
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Infertility - may be temporary or permanent
Lowered resistance to infection
While the chemotherapy drugs are acting on the
leukaemia cells in the body, they also reduce the
number of normal cells in the blood for a while. When
these cells are in short supply, infection is likely.
During chemotherapy the patients blood will be tested
regularly. Tablets or other medicines will probably be
given to reduce the risk of certain types of
infection. Antibiotics will be given antibiotics to
treat any infection. Most infections are caused by
bacteria or viruses already present, but if immunity
is low it is best to avoid crowded places or contact
with anyone who knows they have a bug.
Anaemia
If the level of red blood cells (haemoglobin) in the
blood is low the patient may become very tired,
lethargic and breathless. These are all symptoms of
anaemia - a lack of haemoglobin in the blood. Anaemia
can be very successfully treated by blood
transfusions. The patient should quickly feel more
energetic and the breathlessness will be eased after a
transfusion.
Tiredness (fatigue)
This is a very common effect of chemotherapy. The
fatigue may be due to anaemia, but may also occur as a
result of chemotherapy, even if blood count is normal.
The patient may be especially aware of this when at
home between cycles of chemotherapy and for a few
months after the treatment has finished.
Increased risk of bruising and bleeding
Platelets help blood to clot. With leukaemia, the
number of platelets in the blood is lower than normal,
and chemotherapy may temporarily reduce the numbers
even more. This means that the patient may bruise very
easily and may bleed heavily from even minor cuts and
grazes. The patient may need to have a drip
(transfusion) of platelets before chemotherapy begins,
and at times during treatment, to replace the missing
platelets.
Feeling sick
Some of the drugs used to treat acute myeloid
leukaemia may make the patient feel sick (nausea) and
sometimes may cause vomiting. There are now very
effective anti-sickness drugs (anti-emetics) to
prevent or greatly reduce nausea and vomiting.
Sore mouth
Some chemotherapy drugs can make mouths sore and cause
mouth ulcers. Regular mouthwashes are important. For
infants and people unable to use mouthwash, a soft
diet is recommended.
Changes to the way that the heart works
Some of the drugs used to treat acute myeloid
leukaemia may affect the heart muscle. The doses of
the chemotherapy drugs are carefully monitored, and
heart tests (e.g. cardiac echograms) may be done from
time to time to check the heart function.
Hair loss
Unfortunately, hair loss is another common side effect
of these drugs. People who lose their hair often cover
up by wearing wigs, hats or scarves. Most patients are
entitled to a free wig from the National Health
Service, which most infants are not too bothered
about. Hair will grow back over a period of 3-6 months
when the treatment ends. Although they may be hard to
deal with at the time, these side effects will
disappear once treatment is over.
Follow up
Once treatment is finished, there will be regular
check-ups. These will continue for several years, but
will become less frequent as time goes on.
Blood tests
Regular samples of blood will be taken during and
after treatment to check general health and detect any
abnormal cells in the blood.
Relapse
Chemotherapy may cure the leukaemia. Sometimes,
however, the AML does come back. This is called
relapse. Leukaemia may be resistant to the drugs used
initially, so different drugs or new combinations of
different drugs may be needed to give further
remissions.
Will the treatment affect fertility?
Some of the drugs used to treat acute myeloid
leukaemia can cause temporary or permanent
infertility. Unfortunately, those people who have had
intensive chemotherapy and radiotherapy before a stem
cell or bone marrow transplantation are likely to be
permanently infertile.
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