Leukemia Treatment Options and Associated Adverse Reactions
Leukemia, a type of cancer that originates in the body's bone marrow, is treated with a variety of medications. These include chemotherapy, targeted therapy, immunotherapy, and several other types of drugs. Each medication has its unique mechanism of action and a distinctive set of side effects.
Chemotherapy
Chemotherapy is a broad category of drugs that work by damaging or killing rapidly dividing cells, including cancer cells. Common side effects of chemotherapy include nausea and vomiting, diarrhea or constipation, tiredness, hair loss, skin problems such as rashes, mouth sores, difficulty concentrating, increased risk of infection, and anemia (low red blood cells).
Targeted Therapy
Targeted therapy drugs are designed to attack specific proteins within cancer cells, which helps to stop or slow the growth of cancer. Side effects depend on the specific agent but often include infections, neutropenia (low neutrophil white blood cells), anemia, thrombocytopenia (low platelets), nausea, constipation, cough, fatigue, fever, and injection site reactions such as redness.
For example, Brukinsa (a targeted drug) can cause upper respiratory infections, muscle pain, bleeding, low platelet and neutrophil counts. Rituxan Hycela commonly causes infections, neutropenia, nausea, constipation, fatigue, and injection site reactions depending on the leukemia subtype treated.
Immunotherapy
Immunotherapy stimulates the immune system to fight cancer. Typical side effects include flu-like symptoms such as fever and chills, injection site pain, redness or itching, inflammation (sometimes affecting internal organs), diarrhea, rash, fluid retention, stuffy nose, and higher infection risk.
Additional Notes
Filgrastim, used to promote neutrophil recovery after chemotherapy, may cause bone and back pain, rash, fever, fatigue, cough, dizziness, and low platelet counts; serious side effects include spleen enlargement or rupture and allergic reactions.
Complications of leukemia itself or its treatments include autoimmune hemolytic anemia, immune thrombocytopenia, and Richter syndrome, which may require additional therapies like steroids or antibody treatments.
Other Leukemia Medications
- Antimetabolites, such as cladribine, fludarabine, and pentostatin, mimic the building blocks of DNA and RNA, causing cancer cells to attach to the drug instead of DNA or RNA, preventing them from dividing and multiplying.
- Corticosteroids, including prednisone and dexamethasone, help reduce inflammation and suppress the immune system.
- Phosphoinositide 3-kinase inhibitors (PI3K inhibitors) include idelalisib (Zydelig) and duvelisib (Copiktra).
- Selective inhibitors of nuclear export (SINE) include selinexor (Xpovio).
- Antimitotics prevent mitosis, or cell division, and damage cancer cells, preventing them from dividing and multiplying. Examples include vincristine and vinblastine.
- Bisphosphonates do not directly target cancer cells but can treat the high calcium levels that some leukemias cause, reducing bone breakdown, pain, and the risk of fractures. Examples include zoledronic acid and pamidronate.
- DNA-repair enzyme inhibitors include etoposide (VePesid) and topotecan (Hycamtin).
- Hypomethylating or demethylating agents include decitabine and azacitidine.
- Tyrosine kinase inhibitors include imatinib mesylate (Gleevec), dasatinib (Sprycel), nilotinib (Tasigna), bosutinib (Bosulif).
- Janus-associated kinase (JAK) inhibitors include zanubrutinib (Brukinsa) and ruxolitinib (Jakafi).
- Proteasome inhibitors include bortezomib (Velcade) and carfilzomib (Kyprolis).
- Antitumor antibiotics attach to the DNA in cancer cells to kill them and prevent them from dividing and multiplying. Examples include daunorubicin, doxorubicin, idarubicin, and mitoxantrone.
- DNA-damaging agents, antineoplastics, and alkylating agents alter DNA to prevent cancer cells from growing. Examples include cyclophosphamide, carboplatin, bendamustine hydrochloride, and chlorambucil.
- Asparagine-specific enzymes, derived from Escherichia coli bacteria, break down asparagine to prevent cancer cells from growing. Examples include asparaginase erwinia chrysanthemi and L-asparaginase.
- Immunomodulators include interferon alfa-2a (Roferon-A) and interferon alfa-2b (Intron A).
- Biosimilars have a similar structure and result as biologics but are not identical. Examples include rituximab-arrx and rituximab-abbs.
Doctors consider several factors before recommending a treatment approach for leukemia, including the type of leukemia, the stage of the cancer, a person's age, previous treatments, and the cancer's response to them. Close medical supervision is essential due to the impact of leukemia treatments on the immune system and blood cell production. Discuss specific medications with your oncologist to understand their side effect risks.
- Beyond chemotherapy, other leukemia medications include antimetabolites like cladribine, fludarabine, and pentostatin, which mimic DNA and RNA building blocks, causing cancer cells to attach to the drug instead of DNA or RNA, thereby preventing cell division.
- Corticosteroids, such as prednisone and dexamethasone, are often used to help reduce inflammation and suppress the immune system in leukemia treatments.
- Phosphoinositide 3-kinase inhibitors (PI3K inhibitors) like idelalisib (Zydelig) and duvelisib (Copiktra) are designed to attack specific proteins within cancer cells to stop or slow their growth.
- In the field of oncology, science continues to produce new drugs for leukemia treatments, such as selective inhibitors of nuclear export (SINE) like selinexor (Xpovio), which stimulate the immune system to fight cancer.
