The goal of treating leukemia is to destroy the leukemia cells and return the bone marrow to normal blood production. The treatment varies for different types of leukemia. The choice of treatment options also takes into account factors such as the disease, age, and the overall health of the patient.
Chemotherapy is the most common treatment option, and for certain types of leukemia, targeted therapy may be used. Stem cell transplantation is usually used for patients with leukemia who have a poor prognosis.
Acute lymphoblastic leukemia (ALL)
There are 3 phases of the treatment regimen for acute lymphoblastic leukemia: induction of remission, consolidation, and maintenance.
Induction of remission
The primary goal is to kill as many leukemic cells as possible in the blood and bone marrow. This includes chemotherapy and corticosteroid therapy.
The induction phase of treatment usually lasts 4 weeks and is done in the hospital; however, some patients with acute lymphoblastic leukemia who carry mutations in the BCR/ABL gene (whose corresponding chromosomal abnormality is called the Philadelphia chromosome) may be treated with tyrosine kinase inhibitors.
Consolidation therapy
Aims to kill residual leukemia cells. This is because if these cells regrow, they may lead to relapse. Treatment includes intensive chemotherapy and may also include stem cell transplantation.
This phase may involve prophylactic radiation or chemotherapy to the central nervous system of the brain or spinal cord. Consolidation therapy usually takes several months, but does not require days in the hospital.
Maintenance therapy
Aims to prevent the growth of residual leukemia cells. This phase uses a lower dose of chemotherapy drugs than the induction or consolidation phase. Chemotherapeutic agents are usually given orally (6-MP) or by monthly intravenous infusion of methotrexate. Maintenance therapy usually takes place over 1 to 2 years. During this phase, most people are able to live and work normally.
Leukemia is considered largely cured when the patient has lived normally for more than 5 years. In contrast, if the leukemia does not go into remission, or if it relapses within the first few years, intensive chemotherapy, stem cell transplantation, or participation in a clinical trial of a new drug may be needed.
Acute myeloblastic leukemia (AML)
Treatment of acute myeloblastic leukemia usually consists of two phases, induction of remission and post-remission treatment, and is tailored to the specific cytogenetic abnormalities of the leukemic cells.
Induction of remission
The goal is to kill the leukemia cells in the blood and bone marrow. Chemotherapy drugs are treated by intravenous infusion.
The induction of remission phase usually lasts 4 weeks and consists of 1 week of chemotherapy followed by 3 weeks for bone marrow recovery. The patient spends this month in the hospital.
Post-remission treatment
Kill any remaining leukemia cells. Intensive chemotherapy or stem cell transplantation may be used. The doctor may also recommend that the patient participate in a clinical trial of a new drug. Chemotherapy may require the patient to stay in the hospital a few days a month for a total of 8 to 10 months.
If the patient has the AML subtype of acute promyelocytic leukemia, the patient may be treated with other drugs, such as arsenic trioxide and all-trans-retinoic acid (atRA).
chronic lymphocytic leukemia (CLL)
Chronic lymphocytic leukemia usually does not require immediate treatment. For patients with early stage chronic lymphocytic leukemia, doctors usually recommend “watchful waiting,” meaning that no treatment is given, but periodic reviews are needed to determine disease progression. Many people with chronic lymphocytic leukemia can survive for a long time without treatment.
Once disease progression occurs, your doctor may take the following treatment measures:
- Radiotherapy: used to treat enlarged lymph nodes to prevent too many abnormal lymphocytes from appearing.
- Chemotherapy: usually in combination, which includes targeted therapy with monoclonal antibodies.
Multiple new drugs may also be considered if treatment does not work or if symptoms relapse after a period of remission, and stem cell transplantation is only used for a small number of patients.
Patients with CLL are often prone to infections. Therefore, patients and physicians should pay close attention to all signs of infection, such as pneumonia or fungal infections. Treating the infection early will help prolong survival, and getting the flu vaccine or pneumonia vaccine may help prevent certain infections or diseases. Doctors may also give antibiotics to prevent infections while the patient is being treated.
Chronic myelogenous leukemia (CML)
Chronic myelogenous leukemia (CML) should be treated as soon as it is diagnosed. The most common treatment options include:
- Targeted therapy: Use of tyrosine kinase inhibitors (TKI) (e.g., imatinib). This is the first-line treatment option for CML.
- Stem cell transplantation: This treatment is currently used only in a small number of young patients who have had poor success with targeted therapy and is rarely used anymore.
In patients with early-stage CML (chronic phase), the effects of tyrosine kinase inhibitors can be maintained for many years. If the disease does not relapse, stem cell transplantation may never be needed. Once a relapse occurs, treatment can be switched to a second- or third-generation TKI first, and only a few patients may need a stem cell transplant.
For patients with CML in advanced stages (accelerated or acute), chemotherapy or tyrosine kinase inhibitors may be required before proceeding to stem cell transplantation to increase the success of transplantation.
Childhood leukemia
The treatment of childhood leukemia is different from adult leukemia. Treatment of childhood leukemia requires monitoring for potential side effects of treatment for months or even years after treatment.
Acute lymphoblastic leukemia (ALL) is the most common form of leukemia in childhood and is particularly effective. Treatment of childhood ALL is different from that of adults and varies among infants, children, and adolescents. Treatment options include chemotherapy, radiation therapy, stem cell transplantation in combination with chemotherapy, and targeted therapy.
The treatment options for pediatric acute myeloblastic leukemia (AML) include chemotherapy, radiation, stem cell transplantation, and targeted therapies.