Leukemia: Treatment Options

How is it treated?

Treatment for Leukemia depends on many different factors, most importantly the type of Leukemia and the stage or subtype of the disease. The doctor will also take into account the patient's age, any past history of Leukemia and treatment, and the patient's overall health and personal preferences. Surgery is not an option for treating Leukemia, but there are other options:

Chemotherapy

Chemotherapy is a systemic, or whole body, treatment, the goal of which is to kill any remaining cancer cells in the body and to keep the cancer from spreading to other organs. The drugs are typically given in cycles of a few days of treatment and then 3-4 weeks to rest, for a period of weeks or months determined by the oncologist. There are four ways chemotherapy can be given for Leukemia, depending on patient health and the drugs being used:

• Pill form - Chemotherapy pills are available for some drugs and allow the patient to remain at home for the entire treatment.
  
  
• Intravenous - The most common method of chemotherapy, intravenous injections are usually given on an outpatient basis at the hospital or treatment center. Patients who are in very poor health or have severe side effects may need to remain in the hospital for a few days.
  
  
• Catheter - Special catheters (tubes), inserted by a surgeon, can be used to give chemotherapy drugs and to take further blood samples when needed.
  
  
• Intrathecal Chemotherapy - When Leukemia has spread to the brain and spinal cord, chemotherapy drugs are usually given through a lumbar tap (catheter in the spine) or through an Ommaya Reservoir, a tube placed under the scalp and in some cases directly into the brain.
  

Most Leukemia patients receive their chemotherapy in three rounds. The first round is called induction therapy. This is the combination of drugs used to treat the actual cancer. If, after induction therapy, there is no disease detected, the patient is said to be in remission. A second round of chemotherapy is then given to try and prevent the cancer from coming back. This round is called consolidation treatment. If there is a possibility that the cancer might return, a patient may be put on a lower dose of chemotherapy for several months to three years. This is called maintenance therapy.

Radiation

Radiation therapy is the process in which high-energy light waves are directed at the affected area in order to kill cancer cells. Radiation therapy is usually local, affecting only the area exposed to the rays. It is typically given five days per week for a period of five or six weeks. In Leukemia treatments, total body radiation is also often used to prepare a patient for a bone marrow transplant.

Bone Marrow Transplant

The patient undergoes high doses of total body radiation, chemotherapy, or a combination of the two in order to kill all of the unhealthy blood cells in the body. However, the patient's healthy bone marrow is also destroyed during the treatments. The patient then has to be "rescued" using new, healthy bone marrow. The new bone marrow either comes from a donor (allogenic transplant) or from the patient's own healthy marrow, which was removed and frozen before treatment (autologous transplant). If there is an outside donor, that person's cells must closely match the patient's cells. Therefore, the donor is usually a close relative or someone of similar ethnic background. After the transplant, the patient's immune system is very weak, and he or she must remain in the hospital in a controlled environment until the new marrow has time to rebuild the immune system.

Peripheral Stem Cell Transplant

The procedure for stem cell transplants is very similar to that of a bone marrow transplant. However, instead of using new bone marrow, the transplant uses cells that have already been released into the patient's bloodstream, but can still make all of the different types of blood cells. These stem cells are removed before chemoradiation, frozen, and then re-injected into the patient. The time required to rebuild the immune system is much shorter with stem cell transplants, reducing the risks of infections, and the procedure is less painful for the patient.

Biological Therapy

Biological therapy is a relatively new and still experimental method of cancer treatment. It involves using substances to boost the body's own immune system responses to kill the cancer cells. The most common type of biological therapy used to treat Leukemia is interferon. Retinoic Acid (RA) can be used to treat Acute Promyelocytic Leukemia, a very rare Leukemia. RA appears to repair whatever is blocking the blast cells from making mature, healthy blood cells with fewer side effects than chemotherapy or radiation.

Gleevac

A new drug treatment for people with Chronic Myeloid Leukemia has been showing promising results. The drug works like a missile, killing cancerous cells while leaving healthy ones alone. This is one of the first drugs to target a specific cancer and has been very effective in trials.

What are the side effects of the treatments?

Side Effects from Chemotherapy

Chemotherapy symptoms vary with the drugs being used and among individuals; however, the following are some common side effects:

• Nausea/vomiting
  
• Hair loss
  
• Fatigue
  
• Increased risk of infection
  
• Fever
  
• Easy bruising/ bleeding
  
• Tingling in the fingers and toes
  
• Ringing in the ears/ difficulty hearing
  
• Menopausal symptoms such as hot flashes or vaginal dryness
  
• (Rare) damage to the reproductive organs and/or infertility
  

Side Effects from Radiation

As with chemotherapy, radiation side effects are different for everyone and are usually specific to the areas exposed to the rays. Some commonly reported side effects for Leukemia are:

• Fatigue
  
• Skin irritation
  
• Nausea/vomiting
  
• Diarrhea
  

Side Effects from Bone Marrow and Stem Cell Transplants

• Very high risks of infections and bleeding
  
• Side effects of the intense chemotherapy and radiation
  
• Graft-Versus-Host-Disease (GVHD) - A condition in which the body identifies the donor marrow or blood cells as foreign and begins to attack it along with healthy tissues of the skin, bowel, and liver.
  

Clinical Trials

There are always new experimental treatments being tested that often have promising results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes offer hope of survival especially for end stage cancer patients. Consult your physician or the Rhode Island Cancer Council to find out what clinical trials are going on near you and if you are eligible.

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