← Back
Treatment and the treatment process

Anthracyclines

Anthracyclines are among the strongest and most widely used chemotherapy drugs in leukemia. Many of them are red.

Last updated: ~2 min read
A ruby-red flat molecule sliding between the rungs of a DNA helix on a dark navy background.
Figure 1.An anthracycline slips between the rungs of DNA.

01Short answer

Anthracyclines — daunorubicin, idarubicin and doxorubicin, along with the related mitoxantrone — slip between the strands of DNA and block the enzyme topoisomerase II; this causes DNA breaks and cell death. In AML they are the "3" in "7+3" induction; in ALL they are used in induction and intensification blocks. Most are given by drip, often through a central catheter, because they can damage tissue if they leak under the skin. The most important specific risk is to the heart: it depends on the total (cumulative) amount received and can appear even years later. More common side effects are low blood counts, hair loss, nausea, mouth sores and reddish urine (harmless).

02Simple explanation

A red medicine. Many anthracyclines are red and can briefly turn urine pink.

How does it work? It slips into DNA and damages it.

The heart. The total amount is tracked and the heart is checked.

Careful giving. The drip is closely watched.

03Scientific explanation

Mechanism: intercalation into DNA, blocking topoisomerase II and generating free radicals (NCI, ACS).

Cardiotoxicity: depends on the cumulative dose; risk factors include very young or older age, existing heart disease, chest radiotherapy and high blood pressure. Heart function is checked by echocardiography or MUGA; in some cases (especially children) dexrazoxane may be used to protect the heart. People who had anthracyclines in childhood need long-term heart follow-up.

Extravasation: leakage of the drug outside the vein can damage tissue; pain, burning or swelling at the site should be reported straight away. Liposomal daunorubicin–cytarabine (CPX-351) is used in some types of AML.

04What happens in the body?

How does it work?

The anthracycline molecule slips between the "rungs" of the DNA ladder. The cell cannot unwind and rewind its DNA, and breaks form. The leukemia cell cannot repair them and dies.

Protecting the heart

Before treatment, the heart is checked and the total dose is recorded. If you notice breathlessness, swollen legs or palpitations, tell your doctor.

A translucent heart glowing warm red inside a teal protective shield on a dark background.
Figure 2.During anthracycline treatment, the heart is monitored and protected.

During the infusion

The drug is usually given as a short drip. If you feel pain or burning at the catheter site, tell the nurse straight away. Reddish urine for a day or two is normal.

An infusion bag of ruby-red liquid on a stand in a calm treatment room.
Figure 3.Many anthracyclines are red.

05Treatment with an anthracycline

A simplified outline.

Heart check — Echocardiogram.1Heart checkEchocardiogram.
Infusion — Drip via catheter.2InfusionDrip via catheter.
Dose record — Cumulative amount.3Dose recordCumulative amount.
Long-term follow-up — Heart health.4Long-term follow-upHeart health.
Strong effectIn AML and ALL.
HeartMonitored.
InformationFor future doctors.

06Anthracyclines used in leukemia

DrugWhereNote
DaunorubicinAML, ALLRed; in "7+3"
IdarubicinAML, APLRed; more potent
DoxorubicinALL (some protocols)Red
MitoxantroneAML, relapsesBlue; urine may turn bluish
Liposomal daunorubicin–cytarabineSome AML typesA special form
DexrazoxaneHeart protectionIn selected cases

* Your doctor sets the drug and amount according to the protocol.

07Key terms

Anthracycline
A strong chemotherapy drug that slips into DNA.
Intercalation
A molecule slipping between DNA strands.
Topoisomerase II
An enzyme that unwinds and rewinds DNA.
Cardiotoxicity
A drug’s harmful effect on the heart.
Cumulative dose
The total amount received over a lifetime.
Extravasation
The drug leaking outside the vein.

08Key points

  • Anthracyclines are core drugs in AML and ALL.
  • They slip into DNA and kill the cell.
  • The heart is checked and monitored.
  • The cumulative amount is recorded.
  • Report pain at the infusion site at once.
  • Reddish urine is harmless.

09Frequently asked questions

Why is my urine red?

It is the drug’s colour and passes in a day or two; it is not blood.

Will my heart be damaged?

For most people, no; the risk depends on the total amount and other factors, so it is monitored.

Can I exercise?

After treatment, often yes; discuss your heart test results with your doctor.

What should I remember in future?

That you had anthracyclines and roughly how much; this should be in your treatment summary.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Why is my urine red?

  2. Will my heart be damaged?

  3. Can I exercise?

  4. What should I remember in future?

My questions

12Sources

  1. National Cancer Institute (NCI). Chemotherapy to Treat Cancer
  2. American Cancer Society. How Chemotherapy Drugs Work
  3. Cancer Research UK. Chemotherapy
  4. MedlinePlus. Cancer Chemotherapy
  5. MedlinePlus. Daunorubicin
  6. Macmillan Cancer Support. Cancer treatment and heart health
  7. NHS. Acute lymphoblastic leukaemia: Treatment
  8. Leukemia & Lymphoma Society. ALL treatment
  9. Cancer Research UK. Types of acute lymphoblastic leukaemia (ALL)
  10. Leukemia & Lymphoma Society. ALL subtypes
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
Last updated: ← Back to the list

Open the interactive site →