The goal of treatment for Blood Cancer (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 Blood Cancer (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 Blood Cancer (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 Blood Cancer (Leukemia) may enter a research program when they first start treatment or if the leukemia is not getting better.
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 Blood Cancer (Leukemia)
Unlike acute Blood Cancer (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.
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.
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.
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.
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.
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