What are the most common side effects of ALL treatments and how are they managed?

What are the most common side effects of ALL treatments and how are they managed?

I think the side effects profile of our treatments really depends on what, what class of drugs are used in our therapy. So, in terms of the traditional chemotherapy, the side effects are very similar to a lot of other cancer treatments. So people develop nausea and vomiting, weight loss, hair loss, fatigue, cytopenias meaning that not only are we killing off those leukemia cells, but the other healthy cells, like the red blood cells and these cells called platelets that prevent bleeding, those also go down in addition to the other existing healthy white blood cells. So these therapies don't just kill the leukemia cells, but they also kill all the other blood cells that we need. So patients often require transfusions. They can be toxic to the kidneys. They can be toxic to the liver. So many, many kind of multi-system, side effects can be seen.

That shouldn't scare people off too much. Because one other benefit of, being treated for any disease in 2025 is that the supportive care options that we have are much, much better than they were decades ago. So we have much better, anti-nausea medicines, diarrheal agents, we monitor these patients very closely, and I always inform my patients that we're going to be watching them closely. And anything that we can help with to improve the symptoms as they go through it. those are the side effects we expect to see, in varying degrees of severity in patients who are getting, chemotherapy in terms of the targeted therapy.

So, a blinatumomab one of the concerns that we have using that is that it can cause in the initial, usually with the first cycle or two, we sometimes see some neurologic toxicity. And that can, include anything from a headache to, severe confusion to brain swelling in the most severe cases. Luckily we're much, much better at managing those toxicities now than we were when this drug first came out. In most patients receive the first cycle, sometimes the first two cycles in the hospital so that they can be monitored for those toxicities.

The other thing we see with blinatumomab is a syndrome called CRS or cytokine release syndrome, which looks like a really bad infection. People develop high fevers and low blood pressure. It looks very similar to, a sepsis syndrome. And that's another reason that we monitor people very early on. And we also get preventive steroids before starting the treatment in all patients, with every single cycle. Most people again, have these symptoms early on, and we monitor them for it. And then in subsequent cycles the risk is is much reduced. And really most people tolerate the drug very well.

Inotuzumab does have some unique toxicities as well. We mostly worry about some liver toxicity that can occur during treatment. And the big risk for inotuzumab that we think about a lot before giving. It is a condition called vaso-occlusive disease are also known as sinusoidal obstructive syndrome. It is a type of liver, dysfunction that can occur that can be very severe. It mostly occurs after transplant, especially with using certain pre transplant chemotherapy agents. So, it's something that we think about before giving it and that we monitor for.

CAR-T cell similar to the blinatumomab, we see this syndrome of ICANS. That's the neurotoxicity that we sometimes see with these agents. And then also the cytokine release syndrome, we're learning more. And as we approve more and more, different CAR-T products, we're learning about their unique toxicities and how to prevent it. And luckily, we actually have a new product that, we're able to use now that has a lower risk of some of these adverse effects.

There probably are some longer term side effects that we're learning about, lower blood counts, possibly a propensity toward, other types of blood cancers from the treatment, though, that's ver, new. And we're learning more about it, and we still give these agents in, in the settings that we need them.

you're hematologist psychologist at almost every visit is going to ask you a number of questions about symptoms. And a lot of this is to assess what side effects you might be having related to chemotherapy. So for vinchristine, for example, some side effects include peripheral neuropathy, such as numbness or tingling in the fingers or toes, as well as constipation. The peripheral neuropathy usually presents no numbers for tingling, but sometimes patients can have foot drop or weakness. And so if you're having any problems with balance or coordination or anything like that, it's important to talk with your oncologist about that just because often with a little break in treatment from vinchristine, those side effects will get better and will allow for ongoing treatment without the need for a big interruption that might happen if we let them get too far ahead.

A number of the drugs that we use for ALL treatment can cause nausea, and we're pretty good at managing nausea in the modern era, both with preventive medications that we give at the time of chemotherapy treatment, as well as medications that we can give to patients to take home, to have available for them. Again, it's important to keep your hematologist, oncologist just updated regarding your symptoms so that we can try to find the combination of medicines to support your symptoms. That's right for you.

There are a number of drugs, such as asparaginase that also have unique side effects. I mentioned Asparaginase earlier has a number of side effects related to the liver, and so we need to monitor that closely. Also, patients can have risks of either bleeding or clotting complications. And so for example if you have abnormal swelling in an arm or leg, important to tell your hematology oncology practice, you're having increased bleeding, whether that be rectal bleeding, nose bleed, etc.. Also important to to let us know that. Patients can also, as I mentioned, have nausea, can also have abdominal discomfort, etc. and many of those are symptoms that are manageable. But that we want to know about.

Some patients also will struggle with appetite during portions of therapy. And some of our patients benefit from talking with a nutritionist to make sure that they're able to, adjust their dietary intake, have smaller meals throughout the day, but able to keep up their caloric and nutritional intake and use supplements in some cases to help them through it.

I mentioned some of the side effects of steroids, including on the blood sugar, as well as effects on anxiety and irritability. It's important to tell us about that.

And when it comes to a number of the therapies that can lower the blood counts, and important side effect to watch out for is fevers and chills. For example, if someone is having fevers or chills when they're healthy, white blood cell counts or neutrophils are very low, there could be an increased risk of having infectious complications. And so for those patients, we make sure that they're checked out either in an urgent care or in emergency room or otherwise at a treatment center to make sure that we're not missing an infection like a bloodstream infection.

And so we'll often check blood cultures, urine cultures, do a thorough review of systems, and in many cases will give antibiotic therapy while we're waiting on those cultures, just because the immune system is not able to provide as good a protection against infection as it usually can, we want to make sure that if there is an infection during that, we get on top of it very early.

So definitely let your hematology oncology practice know if you've gotten chemotherapy and you're having fevers or chills.