Chemotherapy for hairy cell leukaemia
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
Chemotherapy is the main treatment for hairy cell leukaemia. The most common chemotherapy drugs are cladribine or pentostatin.
When you have it
You’re likely to have chemotherapy as your main treatment when you are first diagnosed. You usually have one chemotherapy drug, on its own.
You might need further chemotherapy if your leukaemia comes back (relapses). You might have chemotherapy on its own or combined with a targeted drug called rituximab.
Types of chemotherapy
The two main chemotherapy drugs for hairy cell leukaemia are clardibine and pentostatin.
Cladribine (CDA)
You usually have cladribine as an injection just below the skin every day for 5 days in a row.
Some people have cladribine into a vein as a continuous drip (infusion) for 7 days.
There are other ways of having cladribine, including as an infusion over 2 hours for 5 days, or once a week for 6 weeks. Your doctor will talk to you about how you will have it.
Most people have just one course of cladribine.
Pentostatin
You have pentostatin into a vein every 2 weeks, until all signs of the leukaemia have gone or it is under control. The length of treatment varies from one person to another and depends on how the hairy cell leukaemia responds.
Generally the treatment lasts between 3 to 6 months.
Other chemotherapy drugs
You might have a different chemotherapy treatment if the first treatment doesn't work. Or if your leukaemia comes back (relapses) after treatment.You often have this second line chemotherapy combined with the targeted cancer drug rituximab.
You might have a different chemotherapy drug called bendamustine.
How you have it
You might have chemotherapy as an injection under your skin (subcutaneous injection), or as a drip into your bloodstream (infusion).
Injection under the skin
You usually have subcutaneous injections into the stomach, thigh or top of your arm.
The video below shows you how to give an injection just under your skin.
Nurse: This is a short film showing you how to give an injection just under your skin. This is called a subcutaneous or sub cut injection. This does not replace what your doctors and nurses tell you, so always follow their advice.
Voiceover: Subcutaneous injections may be part of your cancer treatment. Or, you may need them to prevent side effects of treatment, such as blood clots after surgery. Or to help control cancer symptoms, such as pain or sickness.
Most injections come in prefilled syringes.
Nurse: So, today I am going to show you how to give a subcutaneous injection. I am going to start by giving it into a practice cushion and then you can have a go at giving one yourself. Before you start, you need to get your equipment together. What you are going to need is an alcohol wipe to clean your skin, some cotton wool, a prefilled syringe and a sharps bin. It is important that you wash your hands with soap and water and dry them thoroughly before you start. Check that you have got the correct drug and that it is in date.
You can give the injection into the back of your arm, your tummy, your thigh or the outer part of your bottom. It is important that you vary where you give the injection. So it may be that you give it one day in your tummy and the next in your thigh.
So you start by cleaning the skin with the alcohol wipe and allowing it to air dry. Then you take the cover off the needle and pinch the skin up and hold it a bit like a pen and in an upright position, in a quick dart like motion pop it straight down into the skin. Then you press the plunger right to the end, quickly pull the needle out, dab it with cotton wool, pop the needle into the sharps bin. And then you need to wash your hands again.
So here’s what you are going to need. If you start by checking the drug and the expiry date. And then with the alcohol wipe give your skin a clean. That’s it give it a few seconds for the air to dry it. Okay and then if you want to pick up the syringe and take the cover off the needle. Then pinch your skin up and at a ninety degree angle gently push the needle in...then press the plunger...and then quickly remove it... dab your skin with the cotton wool and put the syringe in the sharps bin.
Into your bloodstream
You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Where you have chemotherapy
If you have cladribine as an injection under your skin, you might go to the hospital day unit for your injections. Or a district nurse can give them to you at home.
Your nurse might teach you to give them yourself.
If you have chemotherapy as a drip into your bloodstream, you usually have this in hospital. You might have this as an inpatient on the ward, or as an outpatient in the cancer day clinic.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.
Side effects
Common side effects include:
- increased risk of infections
- feeling very tired (fatigue)
- bleeding and bruising easily
- feeling or being sick (nausea and vomiting)
- a skin rash
Side effects depend on:
- which drug you have
- how much of the drug you have
- how you react
Tell your treatment team about any side effects that you have.
When you go home
Chemotherapy for hairy cell leukaemia can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. Your nurse will give you telephone numbers to call if you have any problems at home.
If you have any questions about chemotherapy for hairy cell leukaemia, you can call Cancer Research UK's information nurses on freephone 0808 800 4040, 9am to 5pm, Monday to Friday.
