Short term side effects of treatment for acute lymphoblastic leukaemia (ALL)

Side effects are unwanted things that happen to you as a result of medical treatment. The side effects that you might have and how severe they are depend on a number of factors including:

• the type of treatment you have
• the combination of treatments you have
• the amount (dose) of the drug or radiotherapy
• the way you have a drug – as tablets or capsules, or by injection
• your general health
• your age

Many people are worried about the possible side effects of treatment. All treatments cause some side effects. But side effects vary from one person to another.

Treatments for leukaemia are continuing to improve. This means that more people are surviving with fewer side effects. There are medicines to help control most side effects that happen during or straight after treatment. Many of these effects stop when the treatment ends.

Side effects might be immediate or long term.

Immediate side effects

Immediate side effects happen when you have the treatment or very soon after you finish. The side effects depend on which treatments you have. Some common side effects of treatment for acute lymphoblastic leukaemia include:

An increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should let your doctor or nurse know urgently if you think you have an infection.

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Hair loss

You lose all your hair with ALL treatment. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Sore mouth and ulcers

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually goes back to normal a few weeks after your treatment finishes.

Difficulty eating and drinking

You won't have much appetite just after your transplant. Try small meals throughout the day and eat whenever you feel like it. Your dietitian will give you high calorie drinks if you can't eat much. Or you might have liquid nutrition through a tube into your tummy or through your central line.

Changes in how your heart works

You may have changes to how your heart works. This can cause changes to your heart rhythm and how well it is able to pump blood around your body. Symptoms that your heart is not working properly might include breathlessness when resting or after an activity; feeling tired and lacking energy most of the time and swollen ankles and legs.

Your doctor might ask you to have tests to check your heart, such as an electrocardiogram (ECG).

Periods stopping

Women might stop having periods (amenorrhoea) but this may be temporary.

Possible long term side effects

You might develop long term side effects weeks, months or years after treatment has ended. Some of these include:

• heart problems
• not being able to have children (infertility)
• developing another type of cancer 
• thinning of the bones (osteoporosis)
• early menopause  
• loss of blood supply to the bone (avascular necrosis )
• clouding of the eye lens (cataracts) can happen after an allogenic transplant  

Different types of treatment cause different problems. And doctors can't tell who will get a long term side effect and who won't.

Because treatments have improved over the years, the treatment that people have now is less likely to cause long term problems than treatment in the past.

Coping with late effects

It can be difficult to cope with problems that develop after treatment. You might feel that it's very unfair to have to cope with side effects as well as the leukaemia and its treatment.

Some people find that talking through these issues can help them to cope.

It can also help to know about the risk of developing late effects. Ask your specialist doctor or nurse about possible side effects.

Keeping as healthy as possible can help to reduce the chance of some problems developing. This includes not smoking, eating a well balanced diet, keeping a healthy weight and doing regular physical activity.

Talk to your healthcare team about any symptom that worries you. You don't have to wait for your next appointment.