Treatment
Watchful Waiting
Chemotherapy
Targeted Therapy
Biological Therapy
Radiation Therapy
Stem Cell Transplant
People with leukemia have many treatment options.
The options are watchful waiting, chemotherapy,
targeted therapy, biological therapy, radiation therapy,
and stem cell transplant. If your spleen is enlarged,
your doctor may suggest surgery to remove it.
Sometimes a combination of these treatments is used.
The choice of treatment depends mainly on the
following:
- The type of leukemia (acute or chronic)
- Your age
- Whether leukemia cells were found in your
cerebrospinal fluid
It also may depend on certain features of the
leukemia cells. Your doctor also considers your
symptoms and general health.
People with acute leukemia need to be treated right
away. The goal of treatment is to destroy signs of
leukemia in the body and make symptoms go away.
This is called a remission. After people go into
remission, more therapy may be given to prevent a
relapse. This type of therapy is called consolidation therapy or maintenance therapy. Many people with
acute leukemia can be cured.
If you have chronic leukemia without symptoms,
you may not need cancer treatment right away. Your
doctor will watch your health closely so that treatment
can start when you begin to have symptoms. Not
getting cancer treatment right away is called watchful
waiting.
When treatment for chronic leukemia is needed, it
can often control the disease and its symptoms. People
may receive maintenance therapy to help keep the
cancer in remission, but chronic leukemia can seldom
be cured with chemotherapy. However, stem cell
transplants offer some people with chronic leukemia
the chance for cure.
Your doctor can describe your treatment choices, the
expected results, and the possible side effects. You and
your doctor can work together to develop a treatment
plan that meets your medical and personal needs.
You may want to talk with your doctor about taking
part in a clinical trial, a research study of new
treatment methods. See the Taking Part in Cancer
Research section.
Your doctor may refer you to a specialist, or you
may ask for a referral. Specialists who treat leukemia
include hematologists, medical oncologists, and
radiation oncologists. Pediatric oncologists and
hematologists treat childhood leukemia. Your health
care team may also include an oncology nurse and a
registered dietitian.
Whenever possible, people should be treated at a
medical center that has doctors experienced in treating
leukemia. If this isn't possible, your doctor may
discuss the treatment plan with a specialist at such a
center.
Before treatment starts, ask your health care team to
explain possible side effects and how treatment may
change your normal activities. Because cancer
treatments often damage healthy cells and tissues, side
effects are common. Side effects may not be the same
for each person, and they may change from one
treatment session to the next.
You may want to ask your doctor these
questions before you begin treatment:
- What type of leukemia do I have? How do I
get a copy of the report from the pathologist?
- What are my treatment choices? Which do you
recommend for me? Why?
- Will I have more than one kind of treatment?
How will my treatment change over time?
- What are the expected benefits of each kind of
treatment?
- What are the risks and possible side effects of
each treatment? What can we do to control the
side effects?
- What can I do to prepare for treatment?
- Will I need to stay in the hospital? If so, for
how long?
- What is the treatment likely to cost? Will my
insurance cover the cost?
- How will treatment affect my normal
activities?
- Would a clinical trial be right for me? Can you
help me find one?
- How often should I have checkups?
|
People with chronic lymphocytic leukemia who do
not have symptoms may be able to put off having
cancer treatment. By delaying treatment, they can
avoid the side effects of treatment until they have
symptoms.
If you and your doctor agree that watchful waiting is
a good idea, you'll have regular checkups (such as
every 3 months). You can start treatment if symptoms
occur.
Although watchful waiting avoids or delays the side
effects of cancer treatment, this choice has risks. It may
reduce the chance to control leukemia before it gets
worse.
You may decide against watchful waiting if you
don't want to live with an untreated leukemia. Some
people choose to treat the cancer right away.
If you choose watchful waiting but grow concerned
later, you should discuss your feelings with your
doctor. A different approach is nearly always available.
You may want to ask your doctor these
questions before choosing watchful waiting:
- If I choose watchful waiting, can I change my
mind later on?
- Will the leukemia be harder to treat later?
- How often will I have checkups?
- Between checkups, what problems should I
report?
|
Many people with leukemia are treated with
chemotherapy. Chemotherapy uses drugs to destroy
leukemia cells.
Depending on the type of leukemia, you may
receive a single drug or a combination of two or more
drugs.
You may receive chemotherapy in several different
ways:
- By mouth: Some drugs are pills that you can
swallow.
- Into a vein (IV): The drug is given through a needle
or tube inserted into a vein.
- Through a catheter (a thin, flexible tube): The tube
is placed in a large vein, often in the upper chest. A
tube that stays in place is useful for patients who
need many IV treatments. The health care
professional injects drugs into the catheter, rather
than directly into a vein. This method avoids the
need for many injections, which can cause
discomfort and injure the veins and skin.
- Into the cerebrospinal fluid: If the pathologist
finds leukemia cells in the fluid that fills the spaces
in and around the brain and spinal cord, the doctor
may order intrathecal chemotherapy. The doctor
injects drugs directly into the cerebrospinal fluid.
Intrathecal chemotherapy is given in two ways:
- Into the spinal fluid: The doctor injects the
drugs into the spinal fluid.
- Under the scalp: Children and some adult
patients receive chemotherapy through a special
catheter called an Ommaya reservoir. The doctor
places the catheter under the scalp. The doctor
injects the drugs into the catheter. This method
avoids the pain of injections into the spinal fluid.
Intrathecal chemotherapy is used because many
drugs given by IV or taken by mouth can't pass
through the tightly packed blood vessel walls found
in the brain and spinal cord. This network of blood
vessels is known as the blood-brain barrier.
Chemotherapy is usually given in cycles. Each cycle
has a treatment period followed by a rest period.
You may have your treatment in a clinic, at the
doctor's office, or at home. Some people may need to
stay in the hospital for treatment.
The side effects depend mainly on which drugs are
given and how much. Chemotherapy kills fast-growing
leukemia cells, but the drug can also harm normal cells
that divide rapidly:
- Blood cells: When chemotherapy lowers the levels
of healthy blood cells, you're more likely to get
infections, bruise or bleed easily, and feel very weak
and tired. You'll get blood tests to check for low
levels of blood cells. If your levels are low, your
health care team may stop the chemotherapy for a
while or reduce the dose of drug. There also are
medicines that can help your body make new blood
cells. Or, you may need a blood transfusion.
- Cells in hair roots: Chemotherapy may cause hair
loss. If you lose your hair, it will grow back, but it
may be somewhat different in color and texture.
- Cells that line the digestive tract: Chemotherapy
can cause poor appetite, nausea and vomiting,
diarrhea, or mouth and lip sores. Ask your health
care team about medicines and other ways to help
you cope with these problems.
- Sperm or egg cells: Some types of chemotherapy
can cause infertility.
- Children: Most children treated for leukemia
appear to have normal fertility when they grow
up. However, depending on the drugs and doses
used and the age of the patient, some boys and
girls may be infertile as adults.
- Adult men: Chemotherapy may damage sperm
cells. Men may stop making sperm. Because
these changes to sperm may be permanent, some
men have their sperm frozen and stored before
treatment (sperm banking).
- Adult women: Chemotherapy may damage the
ovaries. Women may have irregular menstrual
periods or periods may stop altogether. Women
may have symptoms of menopause, such as hot
flashes and vaginal dryness. Women who may
want to get pregnant in the future should ask their
health care team about ways to preserve their
eggs before treatment starts.
You may find it helpful to read NCI's booklet
Chemotherapy and You.
People with chronic myeloid leukemia and some
with acute lymphoblastic leukemia may receive drugs
called targeted therapy. Imatinib (Gleevec) tablets were
the first targeted therapy approved for chronic myeloid
leukemia. Other targeted therapy drugs are now used
too.
Targeted therapies use drugs that block the growth of
leukemia cells. For example, a targeted therapy may
block the action of an abnormal protein that stimulates
the growth of leukemia cells.
Side effects include swelling, bloating, and sudden
weight gain. Targeted therapy can also cause anemia,
nausea, vomiting, diarrhea, muscle cramps, or a rash.
Your health care team will monitor you for signs of
problems.
You may want to read the NCI fact sheet Targeted Cancer Therapies: Questions and Answers.
Some people with leukemia receive drugs called
biological therapy. Biological therapy for leukemia is
treatment that improves the body's natural defenses
against the disease.
One type of biological therapy is a substance called a
monoclonal antibody. It's given by IV infusion. This
substance binds to the leukemia cells. One kind of
monoclonal antibody carries a toxin that kills the
leukemia cells. Another kind helps the immune system
destroy leukemia cells.
For some people with chronic myeloid leukemia, the
biological therapy is a drug called interferon. It is
injected under the skin or into a muscle. It can slow the
growth of leukemia cells.
You may have your treatment in a clinic, at the
doctor's office, or in the hospital. Other drugs may be
given at the same time to prevent side effects.
The side effects of biological therapy differ with the
types of substances used, and from person to person.
Biological therapies commonly cause a rash or swelling
where the drug is injected. They also may cause a headache, muscle aches, a fever, or weakness. Your
health care team may check your blood for signs of
anemia and other problems.
You may find it helpful to read NCI's booklet
Biological Therapy.
You may want to ask your doctor these
questions before having chemotherapy, targeted
therapy, or biological therapy:
- Which drugs will I get? What will the
treatment do?
- Should I see my dentist before treatment
begins?
- When will treatment start? When will it end?
How often will I have treatments?
- Where will I go for treatment? Will I have to
stay in the hospital?
- What can I do to take care of myself during
treatment?
- How will we know the treatment is working?
- Will I have side effects during treatment? What
side effects should I tell you about? Can I
prevent or treat any of these side effects?
- Can these drugs cause side effects later on?
- How often will I need checkups?
|
Radiation therapy (also called radiotherapy) uses
high-energy rays to kill leukemia cells. People receive
radiation therapy at a hospital or clinic.
Some people receive radiation from a large machine
that is aimed at the spleen, the brain, or other parts of
the body where leukemia cells have collected. This
type of therapy takes place 5 days a week for several
weeks. Others may receive radiation that is directed to
the whole body. The radiation treatments are given
once or twice a day for a few days, usually before a
stem cell transplant.
The side effects of radiation therapy depend mainly
on the dose of radiation and the part of the body that is
treated. For example, radiation to your abdomen can
cause nausea, vomiting, and diarrhea. In addition, your
skin in the area being treated may become red, dry, and
tender. You also may lose your hair in the treated area.
You are likely to be very tired during radiation
therapy, especially after several weeks of treatment.
Resting is important, but doctors usually advise
patients to try to stay as active as they can.
Although the side effects of radiation therapy can be
distressing, they can usually be treated or controlled.
You can talk with your doctor about ways to ease these
problems.
It may also help to know that, in most cases, the
side effects are not permanent. However, you may
want to discuss with your doctor the possible long-term
effects of radiation treatment.
You may find it helpful to read NCI's booklet
Radiation Therapy and You.
You may want to ask your doctor these
questions before having radiation therapy:
- Why do I need this treatment?
- When will the treatments begin? How often
will they be given? When will they end?
- How will I feel during treatment? Will I be
able to continue my normal activities during
treatment?
- Will there be side effects? How long will they
last?
- Can radiation therapy cause side effects later
on?
- What can I do to take care of myself during
treatment?
- How will we know if the radiation treatment is
working?
- How often will I need checkups?
|
Some people with leukemia receive a stem cell
transplant. A stem cell transplant allows you to be
treated with high doses of drugs, radiation, or both.
The high doses destroy both leukemia cells and normal
blood cells in the bone marrow. After you receive highdose
chemotherapy, radiation therapy, or both, you
receive healthy stem cells through a large vein. (It's
like getting a blood transfusion.) New blood cells
develop from the transplanted stem cells. The new
blood cells replace the ones that were destroyed by
treatment.
Stem cell transplants take place in the hospital. Stem
cells may come from you or from someone who
donates their stem cells to you:
- From you: An autologous stem cell transplant uses
your own stem cells. Before you get the high-dose
chemotherapy or radiation therapy, your stem cells
are removed. The cells may be treated to kill any
leukemia cells present. Your stem cells are frozen
and stored. After you receive high-dose
chemotherapy or radiation therapy, the stored stem
cells are thawed and returned to you.
- From a family member or other donor: An
allogeneic stem cell transplant uses healthy stem
cells from a donor. Your brother, sister, or parent
may be the donor. Sometimes the stem cells come
from a donor who isn't related. Doctors use blood
tests to learn how closely a donor's cells match your
cells.
- From your identical twin: If you have an identical
twin, a syngeneic stem cell transplant uses stem
cells from your healthy twin.
Stem cells come from a few sources. The stem cells
usually come from the blood (peripheral stem cell transplant). Or they can come from the bone marrow
(bone marrow transplant). Another source of stem cells
is umbilical cord blood. Cord blood is taken from a
newborn baby and stored in a freezer. When a person
gets cord blood, it's called an umbilical cord blood transplant.
After a stem cell transplant, you may stay in the
hospital for several weeks or months. You'll be at risk
for infections and bleeding because of the large doses
of chemotherapy or radiation you received. In time, the
transplanted stem cells will begin to produce healthy
blood cells.
Another problem is that graft-versus-host disease
(GVHD) may occur in people who receive donated
stem cells. In GVHD, the donated white blood cells in
the stem cell graft react against the patient's normal
tissues. Most often, the liver, skin, or digestive tract is
affected. GVHD can be mild or very severe. It can
occur any time after the transplant, even years later.
Steroids or other drugs may help.
You may find it helpful to read NCI's fact sheet
Bone Marrow Transplantation and Peripheral Blood
Stem Cell Transplantation: Questions and Answers.
You may want to ask your doctor these
questions before having a stem cell transplant:
- What kind of stem cell transplant will I have?
If I need a donor, how will we find one?
- How long will I be in the hospital? Will I need
special care? How will I be protected from
germs? Will my visitors have to wear a mask?
Will I?
- What care will I need when I leave the
hospital?
- How will we know if the treatment is working?
- What are the risks and the side effects? What
can we do about them?
- What changes in normal activities will be
necessary?
- What is my chance of a full recovery? How
long will that take?
- How often will I need checkups?
|
Back to Top
< Previous Section | Next Section > |