Many leukemia chemotherapy drugs are cytotoxic and do not selectively kill only tumor cells; they can also have adverse effects on normal hematopoietic cells and other tissues. The common toxic side effects include the following.
Alopecia
The chemotherapy drugs that most often cause hair loss are adriamycin, epi-amycin, erythromycin, cyclophosphamide, isocyclophosphamide, methotrexate, pedialyte glycosides, teniposide, and vincristine drugs, among others.
These drugs often cause partial or total hair loss in patients, and the degree of hair loss is related to the type and dose of the drug.
But hair loss due to chemotherapy does not affect the body much, and hair can grow back after stopping chemotherapy drugs, and can be corrected by wearing a wig between chemotherapy sessions.
Gastrointestinal reactions such as nausea and vomiting
Most chemotherapeutic drugs can cause gastrointestinal reactions. The most common adverse reactions to the drug aconitine, which is commonly used in acute myeloid leukemia, are nausea and vomiting, and other drugs such as anthracycline erythromycin, mitoxantrone, and idarubicin, which can cause gastrointestinal reactions of varying degrees, and cyclophosphamide and mercaptopurine, which are commonly used in acute lymphoblastic leukemia, can cause similar reactions.
Gastrointestinal reactions interfere with the patient’s normal diet, leading to inadequate energy intake and weight loss, but there are now more vomiting-preventing drugs used in clinical practice:
- The 5 serotonin receptor blockers granisetron, ondansetron, toltesetron, azelastron, and palonosetron are all more effective in preventing vomiting.
- Glucocorticoids, such as dexamethasone, may be used to enhance antiemetic effects in combination with 5-hydroxytryptamine receptor blockers.
- Other antiemetic agents include NK-1 (P-like substance) receptor antagonists, such as aripitant, which are used primarily in combination with 5 serotonin receptor blockers and/or dexamethasone to increase the efficacy in acute and delayed emesis induced by highly emetogenic chemotherapeutic agents.
- Dopamine receptor blockers, such as metoclopramide, also have some antiemetic effect.
Organic function impairment
Chemotherapeutic drugs are mostly cytotoxic, and in addition to killing tumor cells, they also have different degrees of damage to the body’s organs.
- Anthracyclines mainly affect cardiac function, causing changes in the QT interval, which can lead to arrhythmias and heart failure. Cardioprotective agents such as dexrazoxane can be used for patients with poor underlying cardiac function or high doses of these drugs.
- The drugs are metabolized by the liver and kidneys, which can cause damage to the liver and kidneys and other important organs. Most chemotherapy drugs can cause abnormal liver enzymes and increased bilirubin, and liver-protective drugs can be given during chemotherapy for prevention.
- Cyclophosphamide can cause hemorrhagic cystitis, congestive heart failure, etc. Attention should be paid to adequate hydration and alkalinization during application, and monitoring of the changes in the inlet and outlet volume, and the application should be accompanied by the administration of sodium mesylate.
- High doses of methotrexate can also cause abnormal renal function, again requiring attention to hydration and alkalinization, monitoring of drug concentrations, and timely calcium folinic acid relief.
- Patients with acute lymphoblastic leukemia treated with menadione may experience abnormal coagulation and pancreatitis. Application requires attention to avoid high-fat diet, monitoring of coagulation, and timely infusion of plasma and other supplemental coagulation factors to reduce the occurrence of bleeding.
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Neurotoxicity
Vincristine drugs can cause peripheral neuritis, which clinically manifests as numbness at the ends of the hands and feet, and once it occurs, dose adjustments should be made and nerve-nourishing drugs such as vitamin B12 should be given.
High doses of cytarabine can lead to cerebellar ataxia and sympathetic oculoconjunctivitis, which can be attenuated by giving glucocorticoids along with the drug.
Bone marrow suppression
A period of myelosuppression occurs after administration of chemotherapeutic agents, with allogeneic cytopenia leading to granulocyte deficiency, thrombocytopenia, etc. Severe infections and bleeding from critical sites can be life-threatening.
At this time, we need to pay attention to infection prevention, avoid bumping, eat clean and soft food, give granulocyte colony-stimulating factor (G-CSF) to promote granulocyte recovery, and give blood product replacement therapy to prevent hemorrhage. Also strengthen measures such as mouth rinsing and post-poo sitz baths to avoid oral and perianal infections, and antibiotic prophylaxis if necessary, especially for primary prevention of fungal infections.