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Treatment for leukemia is complex and varies according to the type of leukemia, features of the leukemia cells, extent of the disease, if there has been prior treatment, patient’s age, symptoms, and general health.
Acute leukemia needs to be treated immediately to bring about a remission, followed by therapy to prevent a relapse. Many patients with acute leukemia can be cured.
Chronic leukemia, on the other hand, may not require immediate treatment, but may need frequent checkups to monitor the disease’s progression. When symptoms occur, treatment can often control the disease and its symptoms, but treatment alone can seldom cure it.
The cancer chemotherapy drugs given to patients with acute leukemia are very different from those used to treat chronic cases of leukemia, but they have some things in common. They usually work by disrupting the ability of the cancer cells to grow and multiply. Cancer chemotherapy drugs can be given by several routes—by mouth or injected. When given by mouth, chemotherapeutic agents are absorbed into the bloodstream and are carried throughout the body to reach the cancer cells. At time drugs that cannot be given by mouth, either because they are destroyed in the stomach or because they are not well absorbed, they are injected into the bloodstream. In practice, most drugs given to patients with leukemia are injected or infused directly into a vein—so they reach cancer cells rapidly and without delay.
All chemotherapy drugs have their own specific mode of action—some only kill dividing cancer cells, while others kill all leukemic cells when they are multiplying, while other kill all cancer cells. They can be used alone or in combination with chemotherapy. Most treatments for leukemia include combination chemotherapy and, occasionally, radiation therapy. Such treatments are known as modality treatments.
The amount of a particular drug depends on the patient’s height, weight, and on how the body reacts to it. Unfortunately, these drugs don’t accurately discriminate between normal and leukemia cells, so all cells are affected to some degree and considerable damage can occur to normal tissue in which cell division is rapid. Particular susceptible cells are those in the mouth, stomach, skin, and bone marrow.
Most common chemotherapy drugs are chosen according to the type of leukemia:
· ALL: asparaginase, daunorubicin, vincristine, prednisone, methotrexate
· CLL: fludarbine, chlorambucil, cyclophosphamide, and prednisone
· Hairy cell: pentostatin and cladribine
· CML: alpha interferon and hydroxyurea
Radiation therapy is another form of intensive treatment occasionally used to kill cancer cells by interfering with growth. Radiation therapy for leukemia may be given either to the whole body or to a specific area of the body where there is a collection of leukemia cells, such as the spleen or testicles. It is important to calculate carefully the amount of radiation given because too much is harmful and can cause cancer. Once the treatment plan has been agreed upon, the technique (simulated) and then several markings will be placed on the patient’s skin, ensuring that the same areas (volumes) are treated each day. When radiation is used as part of central nervous system therapy, it’s usually necessary to divide the sessions over ten fractions. The treatment is usually aimed at one of the sanctuary sites. Radiation does cause few side-effects, the usual reversible hair loss; however nausea, skin irritation, and drowsiness may also occur. Very rarely, radiation may cause cataracts in the eye lens. If radiation is given to other areas, such as the testes and ovaries, the most serious side-effect is sterilization but will not affect sexual potency.
Before undergoing a bone marrow transplant, the patient’s leukemia-producing bone marrow is initially destroyed by high doses of drugs and radiation. The affected marrow is then replaced by healthy bone marrow, either from a donor or from the patient, whose marrow was removed, treated outside the body to remove leukemia cells, and stored before the drugs and radiation were given. Patients who have bone marrow transplants usually stay in the hospital for several weeks. Until the transplanted bone marrow begins to produce enough white blood cells, patients have to be carefully protected from infection.
Biological therapy is a type of leukemia treatment improves the body’s natural defenses against cancer. Interferon is a form of biological therapy that can slow the growth of some types of leukemia, such as chronic myeloid leukemia. Some patients with chronic lymphocytic leukemia are given a type of biological therapy called monoclonal antibodies, which bind to the leukemia cells and help the immune system kill leukemia cells in the blood and bone marrow.
Leukemia patient are given high doses of drugs, radiation, or both, which destroy leukemia cells and normal blood cells in the bone marrow. Later the patients can be given healthy stem cells. New blood cells develop from the transplanted stem cells.
Stem cells can be garnered from the patient or from a previous donor. In autologous stem cell transplantation, the patient’s own stem cells are removed and treated to kill any leukemia cells. The stem cells are then frozen and stored. After high-dose chemotherapy and/or radiation therapy, the stored stem cells are thawed and returned to the patient.
In allogeneic stem cell transplantation, healthy donor stem cells are given to the leukemic patient. Donor stem cells can come from brother, sister, or parent but at times comes from an unrelated donor. Doctors use blood test to be sure the donor’s cells match the patient’s cells.
In syngeneic stem cell transplantations, the patient is given stem cells from the patient’s healthy identical twin. There are several types of stem cells transplantation:
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