Is muscle weakness a common side effect of Leukemia treatment? How can it be managed?

Muscle weakness can occur during or after leukemia treatment and is relatively common, often linked to chemotherapy-induced nerve damage (peripheral neuropathy), deconditioning, and treatment-related fatigue. ^[1] Fatigue and weakness vary by drug and dose, and many teams provide support to help manage or prevent daily-life impacts. ^{[2] [3]}

Why weakness happens

• Chemotherapy effects on nerves (CIPN): Some leukemia drugs can injure peripheral nerves, leading to numbness, tingling, pain, and motor problems such as reduced reflexes, balance issues, and muscle weakness. ^[4] These symptoms may affect hands and feet and can interfere with walking and fine motor tasks. ^[5]
• General treatment side effects: Chemotherapy cannot fully distinguish cancer cells from healthy cells, which is why broader side effects like fatigue and reduced physical capacity can occur. ^[6] Chemotherapy is a major treatment modality for leukemias, so these side effects are widely encountered. ^[1]
• Cumulative and dose-related neurotoxicity: Certain anti-cancer agents cause peripheral neuropathy and myopathy; symptoms may improve after stopping therapy, though severe cases can persist longer. ^[7]

How common is it

Chemotherapy-induced peripheral neuropathy is common across cancer populations treated with neurotoxic agents and frequently presents with muscle weakness and balance problems that can limit activities and, at times, necessitate dose adjustments. [PM13] Balance and motor function can be affected in leukemia treatment due to neuropathy and reduced muscle strength and flexibility. [PM14]

Key symptoms to watch

• Sensory changes: Numbness, tingling (“pins and needles”), burning pain, reduced sensation in a “glove and stocking” pattern. ^{[4] [7]}
• Motor changes: Muscle weakness, reduced or absent reflexes, difficulty with gripping, climbing stairs, or walking; unstable gait and increased fall risk. [PM13]
• Functional impact: Trouble with daily activities like buttoning clothes or maintaining balance, which may persist after therapy in some cases. ^[8] [PM15]

Clinical evaluation

• Report symptoms early: Communicate new or worsening weakness, numbness, pain, or balance issues to your care team to allow dose adjustments or supportive interventions. ^[2]
• Neurological exam: Reflex testing, strength grading, sensory assessment, and gait/balance screening to characterize neuropathy and myopathy. ^[4]
• Medication review: Identify neurotoxic agents and cumulative dosing contributing to symptoms to guide modifications when appropriate. ^[7]

Evidence-based management

• Physical therapy and rehabilitation: Targeted programs can improve strength, balance, and walking ability, helping maintain independence and reduce falls. ^[9] Physical therapy is often prescribed to ensure neuropathy doesn’t interfere with balance or daily activities. ^[5]
• Exercise interventions: Sensorimotor training and whole-body vibration have shown promise in reducing CIPN symptoms and attenuating motor and sensory deficits, with potential preventive effects. [PM13] Resistance and balance exercise programs can address gait, balance, and lower extremity strength after chemotherapy-induced neuropathy. [PM15] Structured strength and balance training is supported for individuals at high fall risk due to neuropathy. [PM16]
• Medications for neuropathic pain: Clinicians may prescribe agents to ease discomfort (for example, medications used for nerve pain), which can help you participate in rehab more effectively. ^[5]
• Safety aids and adaptations: Balance aids (canes, walkers), home safety adjustments (remove loose rugs, install grab bars), and footwear with good support can reduce fall risk. ^[9]
• Monitoring and dose adjustments: In some situations, symptoms guide treatment modifications to protect nerve function while maintaining cancer control. [PM13] ^[7]

Practical self-care tips

• Start low, go slow: Begin with gentle exercises (ankle pumps, sit-to-stands, short walks) and progress gradually under guidance to avoid overexertion. [PM16]
• Balance practice: Incorporate safe balance drills (tandem stance near a stable surface), and consider supervised programs if you feel unsteady. [PM15]
• Energy conservation: Pace activities, rest between tasks, and prioritize essential tasks to manage fatigue-related weakness. ^[2]
• Foot care: Check feet daily for injuries when sensation is reduced; wear protective, well-fitting shoes to prevent falls and sores. ^[4]
• Hydration and nutrition: Adequate protein and fluids support recovery and muscle maintenance alongside rehabilitation. ^[2]

When to seek urgent care

• Sudden severe weakness, new falls, or inability to walk: These may indicate significant nerve or muscle involvement and warrant prompt evaluation. ^[4]
• Progressive numbness with functional loss: Contact your team early to consider medication adjustments and targeted therapy. ^[7]

Outlook

Many people experience improvement over months with dose optimization, rehabilitation, and symptom management, though recovery varies and severe cases may persist longer. ^[7] With proactive therapy and supportive care, most can rebuild strength, improve balance, and maintain independence during and after leukemia treatment. ^{[9] [5]}