Chemotherapy (Blood Cancers)

Chemotherapy for blood cancers is a treatment that uses powerful medicines to destroy or slow the growth of cancerous blood cells throughout the body.

Blood cancers — such as leukaemia (cancer of the white blood cells), lymphoma (cancer of the lymph nodes and lymphatic system), and myeloma (cancer of the plasma cells inside bone marrow) — involve abnormal cells that multiply out of control in the blood, bone marrow, or lymph nodes. Chemotherapy drugs travel through the bloodstream and target these rapidly dividing cells, either killing them directly or stopping them from copying themselves. Because the medicines reach the whole body, this is called a systemic treatment, which is particularly suited to cancers that are not confined to one spot.

Chemotherapy is used across a wide range of blood cancers and is often the backbone of treatment, sometimes combined with targeted therapy (medicines that attack specific features of cancer cells), immunotherapy (treatments that help the immune system fight cancer), or radiation. The haematologist (blood cancer specialist) will decide whether chemotherapy is appropriate based on the type of cancer, its stage, and the patient's overall health.

• Acute leukaemia (fast-growing cancers of the white blood cells), including acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML)
• Chronic leukaemia (slower-growing white blood cell cancers), such as chronic lymphocytic leukaemia (CLL) and chronic myeloid leukaemia (CML), in certain situations
• Hodgkin lymphoma (a specific type of lymph node cancer marked by the presence of Reed-Sternberg cells)
• Non-Hodgkin lymphoma (a broad group of lymph node cancers)
• Multiple myeloma (cancer of plasma cells, which are antibody-producing cells in the bone marrow)
• As conditioning therapy — high-dose chemotherapy given before a stem-cell transplant (a procedure that replaces diseased bone marrow with healthy cells) to clear the marrow and suppress the immune system

Chemotherapy may not be the right choice in every case. The doctor will carefully weigh the benefits against the risks, particularly in the following situations:

• Patients with very poor kidney or liver function, because the body may not process or clear the drugs safely
• Patients with certain chronic infections such as hepatitis B or C, where chemotherapy could trigger a flare-up — antiviral medicines are usually given first
• Patients in very frail general health who may not tolerate the side effects
• Some slow-growing blood cancers where a 'watch and wait' approach (careful monitoring without immediate treatment) is preferred over early chemotherapy

Because chemotherapy drugs target rapidly dividing cells, they can also affect healthy cells that naturally divide quickly — such as those in the bone marrow, digestive tract, hair follicles, and mouth — leading to a range of side effects that vary in severity from person to person and from one drug regimen to another.

• Myelosuppression (a drop in blood cell production): low white blood cells increase infection risk, low red blood cells cause anaemia (tiredness and breathlessness), and low platelets (the cells that help blood clot) raise the risk of bleeding or bruising
• Nausea and vomiting, especially in the days immediately following each treatment session
• Fatigue (extreme tiredness) that can persist throughout the treatment course
• Mucositis (painful sores in the mouth or throat) making eating and swallowing uncomfortable
• Hair loss (alopecia), which is usually temporary and reverses after treatment ends
• Increased risk of serious infection due to a weakened immune system — this is one of the most important risks to watch for
• Peripheral neuropathy (tingling, numbness, or pain in the hands and feet) caused by nerve irritation from certain drugs
• Diarrhoea or constipation
• Liver or kidney stress, which is monitored with regular blood tests
• Heart muscle effects with certain drug combinations — the heart is checked before and during treatment
• Fertility changes: some chemotherapy drugs can affect the ability to have children in the future; fertility preservation options are usually discussed before treatment begins
• A small long-term risk of a secondary cancer (a new, different cancer appearing years later), though this risk must be weighed against the serious harm of leaving the original blood cancer untreated

Preparing for chemotherapy for a blood cancer involves several steps that take place over days or even weeks before the first infusion. The goal is to make sure the body is as ready as possible and that the team has a complete picture of the patient's health.

Before treatment begins, the doctor usually orders a set of baseline tests to check overall health and confirm the exact type of blood cancer, because the specific drugs chosen depend on this. Common tests include:

• Full blood count (a blood test that counts the different types of blood cells)
• Bone marrow biopsy (a sample taken from the hip bone to examine the marrow under a microscope) — this is central to diagnosing most blood cancers
• Genetic and molecular tests on the cancer cells, to identify specific mutations (changes in the cell's DNA) that guide drug choice
• Kidney and liver function blood tests
• Heart function test, such as an echocardiogram (an ultrasound scan of the heart), especially if certain drug combinations are planned
• Imaging scans such as CT or PET-CT (a scan that shows where active cancer cells are in the body), particularly for lymphomas
• Infection screening, including tests for hepatitis B, hepatitis C, and HIV
• Fertility counselling and sperm or egg preservation, if the patient is of reproductive age and wishes to consider this

Before each treatment session, patients are advised on the following practical preparations — the team will give specific instructions:

• Fasting is not usually required for standard intravenous (given through a drip into a vein) chemotherapy, but the team will confirm this
• Certain supplements, herbal products, and medicines may interact with chemotherapy drugs — the team will review everything the patient is currently taking
• Alcohol and smoking are best avoided throughout the treatment period, as both can affect how the body handles the drugs and recover between cycles
• A dental check-up is often recommended before treatment starts, because mouth sores are a common side effect and any existing dental problems can worsen

The procedure itself follows a broadly similar pattern for most patients, though the number of sessions, the length of each infusion, and whether treatment is given in hospital or as an outpatient will vary. A typical sequence of steps is:

• 1. A nurse takes a blood sample on the day of treatment to check that blood counts are safe enough to proceed.
• 2. The doctor or pharmacist reviews the results and confirms the drug doses for that session.
• 3. A venous access device is placed if not already in position — most patients receiving multiple cycles have a central line (a thin tube inserted into a large vein near the chest) or a port (a small device placed under the skin) to make repeated infusions easier and protect the arm veins.
• 4. Pre-medications — such as anti-nausea drugs, steroids (anti-inflammatory medicines), and antihistamines — are given through the drip before the chemotherapy starts.
• 5. The chemotherapy drugs are infused one by one; the total time varies from under an hour to a full day depending on the regimen.
• 6. The nurse monitors the patient throughout for any immediate reactions, such as flushing, breathing changes, or a drop in blood pressure.
• 7. After the infusion is complete, the line is flushed and the patient is observed briefly before being discharged or transferred to a ward.
• 8. The cycle then repeats — commonly every few weeks — with rest periods in between to allow the body to recover.

Recovery between chemotherapy cycles — and after the full course ends — requires careful attention because the treatment affects the whole body. The team will provide a personalised plan, but the following points apply to most patients receiving chemotherapy for blood cancer.

• Monitoring location: Many patients are treated as outpatients and go home on the same day, but some regimens — especially intensive ones for acute leukaemia — require a prolonged hospital stay in a specialist unit where the team can respond quickly if infection or bleeding develops.
• Infection precautions: In the days after each cycle, the white blood cell count drops to its lowest point (called the nadir). During this window, patients are usually advised to avoid crowded places, anyone with an active infection, and raw or undercooked food. Fever during this period is treated as a medical emergency — patients are told to go to the hospital immediately.
• Central line or port care: If a central line or port has been inserted, it must be kept clean and dry according to the nurse's instructions, and checked regularly for signs of infection such as redness, swelling, or discharge around the entry site.
• Managing common side effects: The team prescribes anti-nausea medicines, mouth rinses to reduce mucositis risk, and sometimes a growth factor injection (a medicine that stimulates the bone marrow to produce more white blood cells faster) to shorten the period of vulnerability to infection.
• Nutrition: Eating well is important even when nausea reduces appetite. The team may refer the patient to a dietitian for practical advice tailored to the side effects being experienced.
• Activity: Rest is important, but gentle activity such as short walks is encouraged when the patient feels able, as complete bed rest can worsen fatigue over time.
• Follow-up blood tests: Blood counts are checked frequently — often weekly — to track recovery and decide whether the next cycle can proceed on schedule.
• Response assessment: After a set number of cycles, the doctor repeats bone marrow tests and imaging scans to assess how well the cancer is responding. The treatment plan may be adjusted based on these results.
• Emotional wellbeing: The psychological impact of a blood cancer diagnosis and its treatment is significant. Many hospitals offer counselling or support groups, and it is helpful to ask about these services.
• Long-term follow-up: Even after treatment ends, patients attend regular clinic appointments for months to years. These check for cancer recurrence (the cancer coming back), late side effects such as heart or nerve changes, and overall recovery.