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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

For ALL

Most treatment plans for acute lymphoblastic leukemia (ALL) have 3 steps. These are induction, consolidation, and maintenance.

  • Induction therapy kills leukemia cells in the blood and bone marrow to induce remission. Treatments include chemotherapy and corticosteroids. Induction usually lasts 4 weeks and is done in a hospital. But some people who have ALL have leukemia cells with a certain gene change. This gene is called the Philadelphia chromosome. These people will be treated with a tyrosine kinase inhibitor.
  • Consolidation therapy kills 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. Treatments include more chemotherapy and may include stem cell transplant. This step may also include preventive treatment of the brain or spinal cord with radiation or chemotherapy. Consolidation usually takes several months but doesn't require staying overnight in the hospital.
  • Maintenance therapy also prevents any remaining leukemia cells from growing. This may be done using lower doses of chemotherapy than those used during induction or consolidation. Chemotherapy is given with pills and once-a-month intravenous (IV) treatment. Maintenance is often continued for up to 3 years, but during this time, most people are able to go back to being as active as they were before beginning treatment.

When there are no signs of leukemia for 5 years, a person is usually considered cured. But if the leukemia doesn't go into remission, or if it comes back within the first few years, treatments may include more chemotherapy, a stem cell transplant, or joining a clinical trial for new treatments.

For AML

Treatment for acute myelogenous leukemia (AML) will be based on the genetic makeup of your abnormal myeloid cells. This plan usually has 2 steps that includes induction of remission and post-remission therapy.

  • Induction of remission kills leukemia cells in the blood and bone marrow to induce remission. Chemotherapy is given by intravenous (IV) treatment. Induction usually lasts 4 weeks, with a week of chemotherapy and then 3 weeks for bone marrow recovery. During this month you will be in a hospital.
  • Post-remission therapy kills any leukemia cells that may be present even though they don't show up in tests. This therapy may involve getting additional chemotherapy or a stem cell transplant. Or your doctor may recommend that you join a clinical trial for new treatments. Chemotherapy may be given to you in the hospital for several days each month for 3 to 4 months.
  • If you have a subtype of AML called acute promyelocytic leukemia, you may get other medicines, such as arsenic trioxide and all-trans retinoic acid (ATRA).

Stem cell transplants and chemotherapy are also used when leukemia doesn't respond to treatment or if AML comes back after you haven't had symptoms for a period of time.

To learn more about treatment of acute leukemia, see Medications and Other Treatment.

Treatment of chronic leukemia

For CLL

Chronic lymphocytic leukemia (CLL) isn't always treated right away.

Treatment choices for CLL include:

When CLL doesn't respond to treatment, or if it comes back after you haven't had symptoms for a period of time, you may be treated with more chemotherapy or a stem cell transplant. Or your doctor may recommend that you join a clinical trial for new treatments.

When you have CLL, your body isn't 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.

For CML

Chronic myelogenous leukemia (CML) is treated right away. The most common choices include:

For newly diagnosed people in the beginning stages of CML (chronic phase), a tyrosine kinase inhibitor may work for many years. If they don't have a relapse, they may never need to have a stem cell transplant. But if they have a relapse, they may need to have a stem cell transplant.

For people who are diagnosed with CML in the later stages (accelerated or blast crisis phase), treatment may involve having chemotherapy or a tyrosine kinase inhibitor before having a stem cell transplant. This can increase the chances of a successful transplant.

Additional information about leukemia is provided by the National Cancer Institute.

  • For Adult Acute Lymphoblastic Leukemia, see www.cancer.gov/cancertopics/pdq/treatment/adultALL/Patient.
  • For Adult Acute Myeloid Leukemia, see www.cancer.gov/cancertopics/pdq/treatment/adultAML/Patient.
  • For Chronic Lymphocytic Leukemia, see www.cancer.gov/cancertopics/pdq/treatment/CLL/Patient.
  • For Chronic Myelogenous Leukemia, see www.cancer.gov/cancertopics/pdq/treatment/CML/Patient.
  • For Hairy Cell Leukemia, see www.cancer.gov/cancertopics/pdq/treatment/hairy-cell-leukemia/Patient.

Clinical trials

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 who have 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.

Leukemia in children

Treatments for children who have leukemia aren't the same as treatments for adults who have leukemia. After the leukemia has been treated, children may need to be monitored for treatment side effects that may appear months or years later.

For childhood ALL

Acute lymphoblastic leukemia (ALL) is the most common leukemia in children. Treatments for ALL in children aren't the same as treatments for adults, and are different for infants, children, and adolescents. Treatments include chemotherapy, radiation therapy, chemotherapy with stem cell transplant, and targeted therapy.

The 5-year survival rates for childhood ALL are:6

  • For infants up to a year old, 62 out of 100 infants.
  • For children ages 1 to 14, about 89 out of 100 children.
  • For adolescents 15 to 19, about 50 out of 100 adolescents.

Improved treatments have increased survival in infants, children, and adolescents. These numbers are taken from reports that were done at least 10 years ago, before current treatments were available. So your child's actual chances of survival are likely to be higher than these numbers.

For childhood AML and other myeloid diseases

Acute Myelogenous Leukemia (AML) in children is grouped with other myeloid diseases that affect the blood and bone marrow, including chronic myelogenous leukemia. Treatment for each type is different, but include chemotherapy, radiation therapy, stem cell transplant, and targeted therapy.

Survival rates vary widely, depending on the individual child. The 5-year survival rates for childhood AML are:6

  • For children younger than 15, about 58 out of 100 children.
  • For adolescents aged 15 to 19 years, about 40 out of 100.

Improved treatments have increased survival in infants, children, and adolescents. These numbers are taken from reports that were done at least 10 years ago, before current treatments were available. So your child's actual chances of survival are likely to be higher than these numbers.

Additional information about childhood leukemia is provided by the National Cancer Institute.

  • For Childhood Acute Lymphoblastic Leukemia, see www.cancer.gov/cancertopics/pdq/treatment/childALL/Patient.
  • For Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies, see www.cancer.gov/cancertopics/pdq/treatment/childAML/Patient.

Supportive care

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It also can help you with other concerns that you may have when you are living with a serious illness.

For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.

It can be hard to decide when to stop treatment to prolong your life and shift the focus to end-of-life care. For more information, see:

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