Leukemias

Treatment

Just as the symptoms of leukemia differ from patient to patient, so do the treatment options. The factors that influence treatment choices include the type of leukemia, how far the disease has progressed, the patient’s age and symptoms, whether leukemia cells are found in cerebrospinal fluid and whether or not the patient’s leukemia was treated previously.

Within the past decade, physicians have made enormous progress in the treatment of leukemia with new drugs and other therapies, resulting in saved and prolonged lives and significantly improved quality of life for patients.

The treatment options include watchful waiting, chemotherapy, targeted therapy, immunotherapy or biologic therapy, radiation therapy, and stem cell transplantation.

Unlike most cancers that are staged based on the I, II, III and IV stage system reflecting the rate of tumor development and progression, the staging of leukemia depends on a cell classification system that identifies the type of leukemia and helps predict the patient’s outlook for survival. That is because leukemia involves all of the bone marrow in an individual’s body, and in many cases, has already spread to other organs, such as the liver, spleen and lymph nodes, by the time it is diagnosed.

Watchful Waiting

Chronic forms of leukemia in which patients have no symptoms may be initially treated with watchful waiting and then treated when symptoms emerge. By delaying treatment, patients can avoid the side effects of therapy until symptoms develop.

Talk to your doctor to see if a strategy of watchful waiting is best for you. You will receive regular checkups, perhaps every three months, to monitor you health and look for symptoms. However, while watchful waiting avoids or delays side effects, it carries the risk of reducing your chances of controlling leukemia before it gets worse.

Chemotherapy

Most leukemia patients receive chemotherapy drugs to stop abnormal cell growth or kill leukemia cells in the body. Chemotherapy may consist of a single drug or multiple drugs given in combination. The drugs may be administered orally in pill form, as an intravenous injection into a vein or through a catheter placed in a vein, or if leukemia cells are found in cerebrospinal fluid, injected into spinal fluid directly or through a special catheter (called an Ommaya reservoir) placed under the scalp to avoid the direct injections into spinal fluid.

Chemotherapy is usually administered in cycles of treatment followed by a break in treatment. The aim is to effect complete remission of the disease, meaning that all the signs and symptoms disappear, the abnormal leukemia cells are killed off and normal cells are growing in bone marrow. Treatment may be given in a doctor’s office, clinic or hospital.

Targeted Therapy

Targeted therapy is a newer approach to the treatment of chronic myeloid leukemia and acute lymphocytic leukemia that uses drugs to block the production of leukemia cells without killing healthy cells the way chemotherapy does.

For example, one targeted therapy drug used against chronic myeloid leukemia — imatinib (trade name Gleevec) — targets an abnormal enzyme caused by a chromosomal mutation that stimulates the growth of leukemia cells.

Immunotherapy or Biologic Therapy

Immunotherapy, also known as biologic therapy, consists of biologic drugs that boost the immune system, the body’s natural defense against disease, to kill leukemia cells or slow their growth. Immunotherapy is used to treat chronic myeloid leukemia and chronic lymphocytic leukemia.

Monoclonal antibodies are one type of biologic drugs used as immunotherapy against chronic lymphocytic leukemia. They are given by intravenous infusion to kill leukemia cells. Interferon is another type of immunotherapy given to slow the growth of leukemia cells in patients with chronic myeloid leukemia. It is injected into a muscle.

Radiation Therapy

Radiation therapy uses high-energy rays or particles to destroy leukemia cells. Leukemia patients may receive external radiation therapy in a hospital or clinic to kill cancerous cells in the spleen, brain or other organs, or they may receive total-body irradiation for five days a week for several weeks before a stem cell transplant.

Stem Cell Transplantation

A stem cell transplant, also known as a bone marrow transplant depending on the source of the stem cells, is an infusion of healthy stem cells into your body. The cells can come from your own blood or bone marrow or from that of a family member or other donor or from umbilical cord blood.

There are generally two steps to a stem cell transplant. The first is treatment with high doses of radiation or drugs or both followed by an infusion of healthy stem cells through a catheter inserted into a large vein in the neck or chest area, much like a blood transfusion. The stem cells allow healthy new blood cells to develop.

All of the treatments for leukemia involve side effects. See Managing the Side Effects of Treatment.

Forms of Leukemia

This list contains the most common and additional rare forms of leukemia. Included are many of the options used for treatment. They may be used as a single treatment agent, or particularly in the case of the variety of chemotherapy drugs, they are often used in various combinations.