Treatment Side Effects - Damage to Organs

Some of the treatments used to in blood cancer, such as chemotherapy, immunotherapy, and radiation therapy, may cause damage to organs. Certain treatments may damage and affect the functioning of the heart, kidneys, bladder, or liver. In addition, some treatments for blood cancer can damage sex organs and impact a person's fertility, or the ability to have children.^1,2

Heart damage

Radiation therapy that is directed to the chest can cause damage to the heart or the blood vessels that lead to the heart. Some chemotherapy drugs that are used to treat blood cancer can cause side effects of damage to heart tissue, especially anthracyclines, and potentially cyclophosphamide. This is referred to as cardiac toxicity, or damage to the heart from toxic chemicals. There are different types of damage the heart may sustain:

• Cardiomyopathy, which occurs when the heart muscle is weakened and may change the rhythm of the heart or lead to heart failure
• Myocarditis, which is an inflammation of the heart that may change the rhythm of the heart or lead to heart failure
• Pericarditis, which is an inflammation of the sac around the heart and may cause chest pain or heart failure
• Acute coronary syndrome, which is caused by damage to the blood vessels that supply the heart and can cause chest pain or a heart attack
• Congestive heart failure, which occurs when the heart is unable to fully pump blood throughout the body and can become severe, potentially requiring a heart transplant³

Early diagnosis and treatment of heart damage is important to prevent serious, life-threatening complications. People who are receiving treatment or have previously received treatment for blood cancer should tell their doctor if they experience chest pain, changes in the rhythm of the heart (like skipped beats), or feeling short of breath.³

Kidney damage

The kidneys filter waste products out the body, and many drugs are excreted through the kidneys as they produce urine. Chemotherapy or immunotherapy drugs can cause damage to the kidneys by damaging the blood vessels that supply the kidneys or by damaging the tissues of the kidneys themselves. This is called acute renal failure, and it can cause proteins that the body needs to be excreted into the urine and cause an imbalance in the electrolytes in the body. Symptoms of kidney damage include:

• Pain during urination
• An urgency to urinate
• Dark urine or blood in the urine
• A decrease in the amount of urine
• Fatigue or muscle weakness
• Swelling in the feet or ankles
• Nausea
• Vomiting
• Confusion
• Seizure⁴

Kidney damage is usually reversible, but treatment is important. People undergoing treatment for blood cancer that notice any of the signs of kidney damage should report these to their doctor. Untreated kidney damage can have life-threatening complications.⁴

Bladder damage

Some chemotherapy and immunotherapy drugs can cause damage to the bladder or urinary tract, causing urinary tract infections or irritation of the bladder lining, called cystitis. Symptoms include:

• Pain or burning during urination
• Difficulty starting urination
• Difficulty emptying the bladder completely
• An urgency to urinate
• Leaking urine during sneezing or coughing
• Pain or cramps in the back or abdomen^5,6

Urinary tract infections may potentially be prevented through staying hydrated and keeping genitals clean, and if they occur, treatment is available with antibiotics. If a person experiences cystitis, there are medications that can help manage symptoms.^5,6

Liver damage

The liver filters toxins from the blood, and chemotherapy is potentially toxic. If the toxins become more than the liver can handle, liver damage (hepatotoxicity) can occur. Liver damage can be serious, although medications can help manage symptoms. People who are receiving treatment for blood cancer should immediately tell their doctor if they experience any of the symptoms of liver damage, including:

• Yellowing of the skin or eyes (jaundice)
• Fatigue
• Fever
• Abdominal pain
• Severe nausea and vomiting
• Unusual swelling of the feet and legs
• Weight gain of more than 3-5 pounds in a week⁷

Sex organ damage

Chemotherapy and radiation may affect a person's fertility by causing damage to the sex organs (the ovaries, testes, or the pituitary gland). These potential side effects may occur years after treatment. Some chemotherapy agents, like alkylating agents (such as cyclophosphamide or procarbazine), can have a more significant effect on fertility than other drugs, however, it's best to discuss all possible side effects with a physician before treatment begins. Stem cell transplantation, which involves high doses of chemotherapy and an infusion of stem cells, is also associated with a high risk of infertility. Radiation to certain areas may cause infertility, as exposure to the testes, ovaries, or the pituitary gland can all potentially cause infertility. There are ways to preserve the ability to have children, but because some of the options that allow for preserving the ability to have children require action to be taken before treatment starts, it is best to talk to your doctor about the potential side effects of treatment, including its impact on fertility, prior to beginning treatment.²