Leukemia - Treatment Overview

Leukemia - 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 type and subtype 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 three stages:

Induction. The goal of this stage is remission. Remission is a period in which the leukemia cells have been destroyed and are replaced with healthy cells. Induction is done with high doses of powerful drugs which may be given over a period of time from about a week to a month, depending on the type of leukemia. Then it takes several weeks for your body to start growing new blood cells. You probably will stay in the hospital during this time. This can take a month or longer.

Consolidation. Even when tests show no leukemia cells can be found, there may still be some left. The goal of consolidation is to kill any cells that are left. Consolidation often involves the same drugs given in the induction stage, but the schedule and doses may be different. For example, you may receive the drugs in one or two 5-day cycles spread over 1 to 3 months.

Maintenance. The goal of this stage is to prevent leukemia cells from growing back. During maintenance you are given lower doses of drugs over the course of 2 to 3 years. If your type of leukemia has a high risk of coming back (relapse), this stage might include a stem cell transplant. The maintenance stage is not used for all types of leukemia, but is a common part of treatment for acute lymphoblastic leukemia (ALL).

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.

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:

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.

Stem cell transplant . Donated cells from a "matched" donor can rebuild your supply of normal blood cells and your immune system. (A matched donor is usually a family member. But many people have family members whose stem cells are not a close enough match.) Stem cells can be from bone marrow, from the bloodstream, or from umbilical cord blood. If you have a matched donor, drugs and radiation are used to destroy the cells in your bone marrow and make room for donated cells. If you have a relapse after a transplant, a transfusion of more of your donor's white blood cells may put you back into remission.

Drugs. Sometimes different drugs or different doses than those that were used during your initial chemotherapy can help.

Repeating the induction stage. Sometimes the same drugs that put leukemia into remission in the first place will work again.

Treatment of chronic leukemia
Unlike acute leukemia, chronic leukemia is not always treated right away. It usually gets worse more slowly than acute leukemia. This is especially true for chronic lymphocytic leukemia (CLL).

Treatment choices for chronic leukemia include:

Watchful waiting. Treatment is often not needed in the early stages of chronic lymphocytic leukemia (CLL). 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. It is estimated that 1 in 3 people who have CLL never need treatment.8

Stem cell transplant. Some transplants are autologous, meaning the stem cells come from your own body. Some transplants 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.

Biological therapy. This is the use of special drugs that improve your body's natural defenses against cancer. One such drug that doctors often use to treat chronic myelogenous leukemia (CML) is interferon alfa.

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 or to treat CLL.

Clinical trials, which are used to find out whether a medication 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.

Chemotherapy. Chemotherapy is the use of drugs that attack cancer cells. A variety of drugs is available to fight leukemia and help you live longer.

Treatment of infections. When you have chronic leukemia, 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, yeast infections, and shingles. 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.

If you have chronic lymphocytic leukemia (CLL), your doctor may want to check you regularly for other types of cancer. People who have CLL have a higher chance than normal of getting a second cancer.

Treatment if chronic leukemia gets worse
If you have chronic myelogenous leukemia (CML) that gets worse or relapses, there is still much hope. Imatinib (Gleevec) may be combined with other drugs to treat the disease. A new drug called dasatinib (Sprycel) is now available for people whose CML is not helped by imatinib. Other new drugs are also being tested in clinical trials.

If you have a relapse after a bone marrow transplant, a transfusion of more of your donor's white blood cells may put you back into remission.

Palliative care
If leukemia gets worse, you may want to think about focusing on palliative care for your treatment. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from treatment to cure your illness, called curative 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 long-term illness, make future plans around 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.

Leukemia - Topic Overview

Leukemia - Topic Overview

What is leukemia?
Leukemia is cancer of the blood cells. It starts in the bone marrow, the soft tissue inside most bones. Bone marrow is where blood cells are made.

When you are healthy, your bone marrow makes:
White blood cells, which help your body fight infection.
Red blood cells, which carry oxygen to all parts of your body.
Platelets, which help your blood clot.

When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells, they grow faster than normal cells, and they don't stop growing when they should.

Over time, leukemia cells can crowd out the normal blood cells. This can lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain.

Are there different types of leukemia?
There are several different types of leukemia. In general, leukemia is grouped by how fast it gets worse and what kind of white blood cell it affects.

It may be acute or chronic. Acute leukemia gets worse very fast and may make you feel sick right away. Chronic leukemia gets worse slowly and may not cause symptoms for years.

It may be lymphocytic or myelogenous. Lymphocytic (or lymphoblastic) leukemia affects white blood cells called lymphocytes. Myelogenous leukemia affects white blood cells called myelocytes.

The four main types of leukemia are:
Acute lymphoblastic leukemia, or ALL. ALL is the most common leukemia in children. Adults can also get it.
Acute myelogenous leukemia, or AML. AML affects both children and adults.
Chronic lymphocytic leukemia, or CLL. CLL is the most common leukemia in adults, mostly those who are older than 55. Children almost never get it. It sometimes runs in families.
Chronic myelogenous leukemia, or CML. CML occurs mostly in adults.

What causes leukemia?
Experts don't know what causes leukemia. But some things are known to increase the risk of some kinds of leukemia. These things are called risk factors. You are more likely to get leukemia if you:

Were exposed to large amounts of radiation.
Were exposed to certain chemicals at work, such as benzene.
Had some types of chemotherapy to treat another cancer.
Have Down syndrome or some other genetic problems.
Smoke.

But most people who have these risk factors don't get leukemia. And most people who get leukemia do not have any known risk factors.

What are the symptoms?
Symptoms may depend on what type of leukemia you have, but common symptoms include:
Fever and night sweats.
Headaches.
Bruising or bleeding easily.
Bone or joint pain.
A swollen or painful belly from an enlarged spleen.
Swollen lymph nodes in the armpit, neck, or groin.
Getting a lot of infections.
Feeling very tired or weak.
Losing weight and not feeling hungry.

How is leukemia diagnosed?
To find out if you have leukemia, a doctor will:
Ask questions about your past health and symptoms.
Do a physical exam. The doctor will look for swollen lymph nodes and check to see if your spleen or liver is enlarged.
Order blood tests. Leukemia causes a high level of white blood cells and low levels of other types of blood cells.

If your blood tests are not normal, the doctor may want to do a bone marrow biopsy. This test lets the doctor look at cells from inside your bone. This can give key information about what type of leukemia it is so you can get the right treatment.

How is it treated?
What type of treatment you need will depend on many things, including what kind of leukemia you have, how far along it is, and your age and overall health.

If you have acute leukemia, you will need quick treatment to stop the rapid growth of leukemia cells. In many cases, acute leukemia can be cured. Some doctors prefer the term "remission" to "cure," because there is a chance the cancer could come back.

If you have chronic leukemia, you may not need to be treated until you have symptoms. Chronic leukemia can rarely be cured, but treatment can help control the disease.

Treatments for leukemia include:
Chemotherapy, which uses powerful medicines to kill cancer cells. This is the main treatment for most types of leukemia.
Radiation treatments. Radiation therapy uses high-dose X-rays to destroy cancer cells and shrink swollen lymph nodes or an enlarged spleen. It may also be used before a stem cell transplant.
Stem cell transplant. Donated stem cells can rebuild your supply of normal blood cells and boost your immune system. Before the transplant, radiation or chemotherapy is used to destroy cells in bone marrow and make room for donated cells.
Biological therapy. This is the use of special medicines that improve your body's natural defenses against cancer.

For some people, clinical trials are a treatment option. Clinical trials are research projects to test new medicines and other treatments. Often people with chronic leukemia take part in these studies.

Some treatments for leukemia can cause side effects. Your doctor can tell you what problems are common and help you find ways to manage them.

Finding out that you or your child has leukemia can be a terrible shock. It may help to:
Learn all you can about the type of leukemia you have and its treatment. This will help you make the best choices and know what to expect.
Stay as strong and well as possible. A healthy diet, plenty of rest, and regular exercise can help.
Talk to other people or families who have faced this disease. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

Frequently Asked Questions
Learning about leukemia:
What is leukemia?
What causes it?
Can I prevent leukemia?
What are the symptoms?
What increases my chances of getting leukemia?
How common is it?
What happens in leukemia?

Being diagnosed:
How will my doctor diagnose leukemia?
What is a bone marrow aspiration and biopsy?
Getting treatment:
How is leukemia treated?
What type of medicines will I need to take?
What is radiation therapy?
What is a bone marrow transplant?
What is a stem cell transplant?
What is a clinical trial?
When is surgery needed?

Ongoing concerns:
When should I call my doctor?

Living with leukemia:
What can I do at home to ease my symptoms or manage the side effects of treatment?
How can I control nausea and vomiting caused by chemotherapy?

End-of-life issues:
How can I prepare for end-of-life issues?