Although the incidence of leukemia has not changed much since the 1950s, more patients have survived significantly longer because of advances in chemotherapy regimens. For example, pediatric leukemia (3/4 of pediatric patients have acute lymphoblastic leukemia) is one of the most dramatic success stories of advances in cancer treatment. To date, the five-year survival rate for pediatric acute lymphoblastic leukemia patients has risen to about 85%.
Acute leukemia
For patients with acute leukemia, the immediate treatment goal is to achieve remission. Patients need to be hospitalized for chemotherapy, preferably in a single room to reduce the risk of infection.
Because patients with acute leukemia have extremely low numbers of healthy blood cells, they need to:
- Blood transfusions and platelet transfusions to avoid or stop bleeding;
- along with antibiotics to prevent or treat infection;
- and related medications to alleviate treatment side effects.
Patients with acute leukemia can achieve remission using chemotherapy as the initial treatment regimen. To better control the disease, consolidation chemotherapy is continued for 1 to 4 months to remove residual tumor cells. This is usually followed by up to two years of intermittent treatment.
After achieving complete remission, some patients with acute myeloblastic leukemia (AML) may require allogeneic stem cell transplantation, which requires a genotype-matched donor to provide stem cells for transplantation. Often the best match tends to be a family member of the patient, and other sources of stem cells include genetically matched volunteer donors or stored cord blood stem cells.
There are 3 stages of stem cell transplantation: induction chemotherapy, high-dose prep, and stem cell transplantation.
Before the transplanted bone marrow stem cells begin to produce new blood cells, the patient has few new blood cells – including white blood cells, red blood cells, or platelets , which puts the patient at extremely high risk of infection or bleeding to death. Once the donor stem cells enter the patient’s bone marrow and are fully grown within 2 to 6 weeks, the patient is well positioned to achieve long-term remission.
In addition to the chemotherapy regimen, patients will also receive medications to combat graft-versus-host disease. If this disease occurs, the graft cells will attack the normal cells in the body. Medications are also needed to prevent the patient from rejecting the transplanted stem cells.
Allogeneic stem cell transplantation is expensive and risky, but it offers the best option for achieving long-term remission in patients with high-risk acute myeloid leukemia and some patients with acute lymphoblastic leukemia.
If the above treatment options do not work in children and young patients with acute B lymphoblastic leukemia, or if the tumor relapses, then doctors may try to treat with a new gene therapy. The company’s main goal is to provide a better understanding of the marketplace and the marketplace. But it can also have serious side effects during treatment, and only accredited medical centers are allowed to carry out this treatment program.
Chronic leukemia
Chronic lymphocytic leukemia (CLL) is a leukemia that commonly occurs in the elderly population and progresses slowly. Therefore, a more conservative treatment plan is possible.
Not all patients need to be treated immediately after diagnosis, but only if they develop certain clinical symptoms. Such symptoms include:
- Fever and profuse night sweats for 14 consecutive days;
- Unexplained weight loss of 10% within 6 months;
- Painful swelling of the lymph glands, painful swelling of the liver and spleen, and bone marrow failure.
Oral chemotherapy drugs can effectively control the symptoms of chronic myeloid leukemia for up to several years.
In the past, because most patients with chronic myeloid leukemia would eventually progress to the acute phase even with treatment, doctors usually recommended that patients undergo a bone marrow transplant in the chronic phase. Currently, patients with chronic myeloid leukemia who have failed drug therapy or are in the acute phase can still be treated with allogeneic stem cell transplantation.
The introduction of imatinib has revolutionized the concept of treatment for chronic myeloid leukemia. It is a molecularly targeted drug that attacks the genetic variants that cause uncontrolled leukocyte growth. Imatinib cannot achieve a cure, but treatment can provide long-term remission and improve the survival of patients with chronic myeloid leukemia. It is significantly superior to previous regimens such as leukodiazepine, hydroxyurea, and alpha interferon.
If patients become resistant to imatinib, there are now 4 other drugs available – bosutinib, dasatinib, nilotinib, and ponatinib.
- Nilotinib has been approved by the FDA for the treatment of chronic myeloid leukemia in the chronic phase.
- Dasatinib has been approved by the FDA as a first-line treatment for chronic myeloid leukemia in the chronic phase.
- Patients with chronic myeloid leukemia in any stage who experience drug therapy failure or intolerable side effects of the drug can switch to treatment with bosutinib or ponatinib.
There is also a drug called hypertrigonelline that has been approved for the treatment of patients with chronic myeloid leukemia who have failed to respond to 2 or more prior regimens and whose disease continues to progress.