Patients report side effects at each follow-up visit. Assembling this information often falls to nursing professionals who spend more time with patients. However, this is extremely important. For example, damage to heart muscle from anthracyclines can be minimised by adjusting the dose or prescribing a different drug.
Targeted drugs have specific side effects according to their mechanism of action (Table 4). They often cause less side effects than chemotherapy because they target specific components of the leukaemia cell.
Table 4 Specific side effects for drugs for AML
| Drug type | Drug | Specific side effect |
| Targeted drug | Midostaurin | Oedema of hands, feet and ankles
Hyperglycaemia |
| Gilteritinib | Abnormal liver tests
Heart rhythm disturbances Seizures or confusion Differentiation syndrome1 |
|
| Gemtuzumab ozogamicin | Swelling and sores in the mouth
Allergic reactions on infusion Disturbances in heart rhythm Serious/life-threatening infections Severe liver damage, including veno-occlusive disease (blockage of veins in the liver) |
|
| Glasdegib | Muscle spasms | |
| Venetoclax | Pneumonia and other serious infections
Tumour lysis syndrome2 |
|
| Anthracycline | Daunorubicin Doxorubicin | Heart rhythm disturbances (short-term)
Heart muscle damage (long-term) |
1 Differentiation syndrome is a rare but serious side effect. This syndrome includes fever, fluid build-up in the lungs and around the heart, low blood pressure and liver or kidney damage. It is caused when the patient has a large number of leukaemia cells that release cytokines (immune substances). Stopping gilteritinib for a while and treatment with steroids can help improve symptoms
2 Tumour lysis syndrome occurs in patients who have large numbers of leukaemia cells at the start of treatment. As they are rapidly destroyed, these leukaemia cells release uric acid, potassium, and phosphorus in the blood faster than the kidney can excrete them. These raised levels of electrolytes can cause damage to the kidneys, heart or liver
