There are two cell populations in the bone marrow of leukemia patients, normal polyclonal hematopoiesis and leukemic monoclonal hematopoiesis, and the goal of leukemia treatment is to kill the leukemic clone and restore durable normal polyclonal hematopoiesis.
Acute myeloid leukemia (AML)
Treatment of acute myeloid leukemia (AML) should be done in phases:
- Phase I is induction therapy, which aims to kill leukemic cells and achieve normalization of routine bone marrow tests;
- The second phase is post-remission therapy (including consolidation, intensive, maintenance therapy and extramedullary leukemia control and hematopoietic stem cell transplantation), which aims to remove residual leukemia cells that cannot be detected by conventional examination methods in order to reduce relapse and strive for long-term survival.
Post-remission treatment can be artificially divided into several phases:
- The first phase is consolidation therapy, which is usually a repeat of the original induction regimen for 1 to 2 courses and may be modified;
- The second phase is intensive therapy, which not only involves higher doses than induction chemotherapy but also often involves adding or switching to the original induction regimen for one to several courses; the final phase of postremission therapy is maintenance therapy, which involves the application of smaller doses of chemotherapy that do not cause significant myelosuppression, usually for longer periods of time; postremission therapy for AML also includes the use of stem cell transplantation.
Acute lymphoblastic leukemia (ALL)
The treatment of acute lymphoblastic leukemia (ALL) is holistic and includes supportive therapy and anti-leukemic therapy. Supportive therapy is important to ensure the efficacy of anti-leukemic therapy. In addition, the treatment of acute lymphoblastic leukemia (ALL) is an integral part of supportive therapy and anti-leukemic therapy.
The goal of induction therapy is to rapidly remove more than 99% of the body’s leukemic cell load, re-establish normal hematopoiesis, and restore the function of damaged tissues and organs. After induction therapy has achieved “complete remission”, there are still 109 or less residual leukemia cells in the body, which is the source of leukemia relapse.
Post-remission treatment, including consolidation and maintenance therapy and CNS leukemia control, aims to destroy these residual leukemia cells in the body, prevent drug resistance and relapse, prolong survival, and strive for a cure.
Chronic myeloid leukemia (CML)
Chronic myeloid leukemia (CML) has changed dramatically over the past 20 years or so, with the successful clinical use of imatinib mesylate (IM) in the late 1990s ushering in an era of molecularly targeted tumor therapy with significantly longer patient survival. Interferon, which was the treatment of choice for CML patients lacking transplantation in the 1990s, is no longer recommended as first-line therapy.
With the prolonged clinical use of IM, the problem of IM resistance has gradually emerged, and tyrosine kinase inhibitors such as second- and third-generation continue to be introduced with encouraging clinical trial results, and it is believed that more CML patients will benefit in the near future.
Chronic lymphocytic leukemia (CLL)
Chronic lymphocytic leukemia (CLL) usually does not require immediate treatment, but rather watchful waiting. Watchful waiting means that the doctor will check regularly to determine how the patient’s disease is progressing, but will not treat it. For patients with early CLL, doctors may choose watchful waiting because these patients can usually survive for a long time without treatment.
However, watchful waiting is not usually recommended for other types of leukemia. During watchful waiting, patients need to:
- Revisit regularly for all necessary tests, including imaging and blood work;
- Learn to watch for symptoms and know how to determine when immediate medical attention is needed.