|
Once acute lymphocytic leukemia (ALL) or acute myelogenous leukemia (AML) is diagnosed, doctors start treating it right away because it tends to worsen quickly. Their goal is to bring about a complete remission, which means that there would be no evidence of leukemia in the bone marrow or blood. Then they can give further treatment to help prevent a relapse. Many people with the acute forms of leukemia can be cured.
Great advances have been made in treating childhood ALL, which accounts for more than 75 percent of cases of acute leukemia in children. Just a few decades ago it was considered incurable, but now it is one of the most curable forms of cancer.
People with chronic lymphocytic leukemia (CLL) may not require treatment right away or for many years if they are not experiencing symptoms yet. Their condition may have been detected through a routine blood test. However, chronic myelogenous leukemia (CML) is treated early if white blood counts are high. Their doctors monitor the progress of the disease until treatment is needed. It usually cannot be cured, but it can be controlled. Newer treatment for CML with Gleevec® (imatinib mesylate) has shown spectacular results.
The most common treatments for leukemia are chemotherapy, radiation therapy and/or bone marrow transplantation.
Chemotherapy: Patients who have chemotherapy take one or more anti-cancer drugs by mouth or intravenously (through a tube in one of the veins). Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. The drugs enter the bloodstream and destroy leukemia cells throughout the body. However, they cannot reach the brain and spinal cord, because of a protective network of blood vessels that keeps foreign substances from entering the central nervous system. In certain cases, doctors need to inject the drugs directly into the fluid that surrounds the brain and spinal cord.
Radiation: Radiation therapy uses a special machine to deliver high-energy rays that damage cancer cells and stop them from growing. These rays may be directed at the entire body, or they may be focused on certain areas where leukemia cells are collecting.
Bone marrow transplantation: In many cases of acute leukemia and CML, doctors give high doses of chemotherapy and radiation, when indicated, to destroy all of the patient's bone marrow, since it is not functioning correctly. Then they give the patient healthy bone marrow from a donor (allogeneic bone marrow transplant), whose tissue is the same or almost the same as theirs; ideally, an identical twin or a sibling. They also might give bone marrow that was removed from the patient earlier (autologous bone marrow transplant) and specially treated to remove any leukemia cells. Patients who have a bone marrow transplant usually stay in the hospital for several weeks. The risk of infection and bleeding is high until the transplanted bone marrow begins to produce enough white blood cells.
Apheresis for stem cell transplants: This is newer technology, which separates the bone marrow stem cells. Stem cells are rare, young bone marrow cells that eventually develop into the plentiful, mature red cells, white cells and platelets. Before chemotherapy or radiation therapy for leukemia, a patient is given a drug to induce production of many stem cells over a few days. Once there are enough stem cells to collect, the patient undergoes "apheresis," a three- to four-hour procedure where blood goes through a machine and returns to the body. Stem cells collected in this process are given intravenously and serve as new bone marrow for transplant.
Biological therapy: The newest form of treatment under investigation is called biological therapy, which uses substances that help your immune system to treat cancer or the side effects of chemotherapy. The body naturally produces interferon and interleukin that gear up the immune system to fight off bacteria, viruses and other harmful invaders. These and other substances can also be produced as medicines to treat cancer.
Vaccines are medicines that prevent diseases caused by bacteria, viruses and other microorganisms. A vaccination is given before someone is exposed to the microorganism, and "trains" the immune system to recognize the disease-causing agent. Vaccines are also a form of biological therapy being developed for certain cancers, such as melanoma and renal cell carcinoma (kidney cancer). They are given as part of experimental protocols after the disease is diagnosed and have been shown to help fight the cancer and keep it from returning. In December 2004, a meeting of the America Society of Hematology reported that a vaccine improved survival in myeloid leukemias (AML and CML).
PR1 is a protein found on the surface of AML and CML cells, but remains hidden and out of view from the immune system in normal white blood cells. The experimental vaccine is made from the PR1 protein and induced an effective immune response; antibodies killed PR1 cancer cells and prolonged progression free survival in AML and CML patients for about four months.
Molecular targeting -- treatment of the future: In 2001 the FDA approved the oral medication Gleevec for a rare, fatal type of leukemia. This breakthrough drug, intended for CML, kills cancerous cells only. It does not harm healthy cells. Gleevec is a type of treatment called molecular targeting. It interferes with how CML works at a molecular level, shutting down a key protein that drives CML's abnormal cell growth. So far, the side effects of the drug are not severe. It can cause nausea and some abdominal problems and skin rash.
Dr. Brian Druker, one of Gleevec's developers, noted that patients with CML who made no progress with any other treatment responded well to Gleevec. Doctors hope the drug may be just as successful at curing other cancers such as intestinal, brain or lung cancers. Long-term effects, total side effects and Gleevec's long-range effect on survival, however, are not fully known.
|
Related Articles
|
|
External Sources
 |
US Food and Drug Administration
|
|
US Public Health Service and Department of Health and Human Services
|
|
Leukemia: Research Report. Washington, DC: National Cancer Institute publication NIH.
|
|
What You Need to Know About Leukemia. Washington, DC: National Cancer Institute publication NIH
|
|
Leukemia Society of America, 600 Third Avenue, New York, NY, 10016
|
|
Leukemia Research Foundation, 820 Davis Street, Suite 420, Evanston, IL 60201
|
|
Rosenbaum, EH, Rosenbaum, I, Everyone's Guide to Supportive Cancer Care: The Complete Guide for Patients and Their Families, Fourth Edition, Kansas City, Missouri: Andrews McMeel Publishing, 2005
|
|
Dollinger M, Rosenbaum, EH, Tempero M., et al. Everyone's Guide to Cancer Therapy, Fourth Edition, Kansas City, Missouri: Andrews McMeel Publishing, 2002
|
|
This article was reviewed and updated June 2007.
Return to the previous page
|
