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Leukemia (cont.)

Treatment Overview

The goal of treatment for leukemia is to destroy the leukemia cells and allow normal cells to form in your bone marrow. Treatment decisions are based on the kind of leukemia you have, its stage, and your age and general health.

Treatment for acute leukemia

Chemotherapy is the use of drugs to fight cancer. It is the usual treatment for acute leukemia. For most people, that means receiving drugs in stages:

  • The goal of induction is to kill leukemia cells in the blood and bone marrow to induce remission. During remission, there are no signs or symptoms of leukemia.
  • The goal of consolidation is to kill any leukemia cells that may be present even though they don't show up in tests. If these cells regrow, they could cause a relapse.
  • The goal of maintenance also is to prevent any remaining leukemia cells from growing. This may be done using lower doses of chemotherapy than those used during induction or consolidation. This is only used in people with ALL and a few rare forms of AML.

Some types of acute leukemia spread to the brain and spinal cord. Regular chemotherapy cannot reach those areas, because your body puts up a special barrier to protect them. A different way of giving chemotherapy, called intrathecal chemotherapy, treats these areas by injecting the drugs directly into your spinal canal to attack any leukemia cells there.

Radiation therapy uses high doses of radiation, such as X-rays, to destroy cancer cells. Radiation is usually given from a machine outside the body that directs radiation to the cancer (external radiation). Radiation is also used to treat acute leukemia that has spread to the brain and spinal cord.

Stem cell transplant may be part of the treatment plan for people who have high-risk acute leukemia. Most stem cell transplants for leukemia are allogeneic, meaning the stem cells are donated by someone else. The goal of a transplant is to destroy all the cells in your bone marrow, including the leukemia cells, and replace them with new, normal cells.

Treatment if acute leukemia gets worse

Sometimes leukemia gets worse in spite of treatments. Sometimes it gets better, or "goes into remission." Sometimes it comes back, or "relapses." Even when that happens, there are several treatments that may help to cure the leukemia or help you live longer:

  • Stem cell transplant. Donated cells from a "matched" donor can rebuild your supply of normal blood cells and your immune system.
  • Chemotherapy. Sometimes medicines or doses that are different from those used during your initial chemotherapy can help.

Clinical trials. People who have leukemia may enter a research program when they first start treatment or if the leukemia is not getting better. These programs test new ways to treat the disease. For more information, see www.cancer.gov/clinical_trials/ or http://clinicaltrials.gov.

For more information about acute leukemias in adults, see the following topics:

Treatment of chronic leukemia

Chronic lymphocytic leukemia (CLL)

Chronic lymphocytic leukemia is not always treated right away. It usually gets worse more slowly than acute leukemia.

Treatment choices for CLL include:

  • Watchful waiting. CLL usually gets worse very slowly, and you may have no symptoms for some time. You and your doctor may decide to hold off on treatment for a while. During this time your doctor will watch you carefully.
  • Radiation therapy. Radiation may be used to destroy cancer cells. It also may be used to shrink swollen lymph nodes or a swollen spleen. Sometimes radiation is used on the whole body to prepare for a bone marrow transplant.
  • Chemotherapy. Chemotherapy is the use of medicines that attack cancer cells. Many medicines are available to fight leukemia and help you live longer.
  • Surgery. If the spleen starts destroying red blood cells and platelets, it may need to be removed. This operation is called a splenectomy.
  • Targeted therapy with a monoclonal antibody. These antibodies can kill cancer cells, stop their growth, or keep them from spreading.

When you have CLL, your body is not able to fight infections very well. You and your doctor need to watch for any signs of infections, such as pneumonia or yeast infections. Early treatment of these and other infections will help you live longer. You can sometimes prevent certain infections or keep from getting very sick by getting a flu shot or a pneumonia vaccine. Your doctor also may give you antibiotics to prevent infection while you are being treated for leukemia.

Chronic myelogenous leukemia (CML)

Chronic myelogenous leukemia is treated right away.

Treatment choices for CML include:

  • Targeted therapy with a tyrosine kinase inhibitor, such as imatinib or dasatinib, is the first treatment used for CML.
  • Chemotherapy. Chemotherapy is the use of medicines that attack cancer cells. Many medicines are available to fight leukemia and help you live longer.
  • Biological therapy. This is the use of special medicines that improve your body's natural defenses against cancer.
  • High-dose chemotherapy with stem cell transplant. After chemotherapy is completed, stem cells that were previously donated and frozen are thawed and infused.
  • Donor lymphocyte infusion (DLI). This is a treatment that may be used after a stem cell transplant. With DLI, a person is given more of their donor's white blood cells (lymphocytes).
  • Surgery. If the spleen starts destroying red blood cells and platelets, it may need to be removed. This operation is called a splenectomy.

Clinical trials are used to find out whether a medicine or treatment is safe and effective. People who have chronic leukemia are often referred to clinical trials for their treatment. For more information, see www.cancer.gov/clinical_trials/ or http://clinicaltrials.gov.

For more information about chronic leukemias in adults, see the following topics:

For information about hairy cell leukemia, see the following topics:

Leukemia in children

Treatments for children who have leukemia are not the same as treatments for adults who have leukemia. Children may respond and react to treatments in ways that are different from how adults respond. Also, after the leukemia has been treated, children may need to be monitored for treatment side effects that may appear months or years later.

Leukemia in children is usually treated by a medical team led by a pediatric oncologist.

For more information about childhood leukemias, see the following topics:

Palliative care

If you have leukemia, you may want to consider having palliative care along with your treatments. Palliative care is a kind of care for people who have serious illnesses. It can help you manage symptoms from your treatment. Palliative care focuses on improving your quality of life—not just in your body but also in your mind and spirit.

Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a serious illness, make future plans for your medical care, or help your family better understand your illness and how to support you.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life issues

Even if your treatment is going well, it's a good idea to plan ahead. Talk to your family and your doctor about health care and other legal issues that arise near the end of life. Put your health care choices in writing (with an advance directive or living will). This is important, if a time comes when you can't make and communicate these decisions. Think about your treatment options and which kind of treatment will be best for you. You may also want to choose a health care agent to make and carry out decisions about your care if you become unable to speak for yourself.

For more information, see the topics Writing an Advance Directive and Choosing a Health Care Agent.

A time may come when your goals may change from treating an illness to maintaining your comfort and dignity. Your doctor can address questions or concerns about maintaining your comfort when cure is no longer an option. Hospice care professionals can provide palliative care in the comfortable surroundings of your own home.

For more information, see the topics Palliative Care, Hospice Care, and Care at the End of Life.

What to think about

When leukemia has been in remission for a long time, the word "cure" is often used. Your doctor may use the term "remission" instead of "cure" when talking about the effectiveness of your treatment. Although many people who have leukemia are successfully treated, the term remission is used because cancer can return (recur). It is important to discuss the possibility of recurrence with your doctor.

Clinical trials play a very important part in the treatment of leukemia. Clinical trials test the latest drugs and other new treatments. They have made it possible for many people with leukemia to live longer. People who are in clinical trials get all the recommended treatments for their cancer and are closely watched. Talk to your doctor about whether there is a clinical trial that might be good for you. For more information, see www.cancer.gov/clinical_trials/ or http://clinicaltrials.gov.

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