Treatment Options for Leukemia

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There are many options when it comes to treating leukemia. The best choice for someone with leukemia will depend on the person and the type of leukemia he or she has. The main treatment for most types of leukemia is chemotherapy. But, there are other options. They include a stem cell transplant, radiation therapy, immunotherapy, and surgery. New advances in treatment include targeted therapy based on the genetics of a person's cancer.

Chemotherapy is medication that treats leukemia. These drugs can be pills or injections. Basic things to know include:

• Chemotherapy kills rapidly dividing cells. This includes some normal cells. Chemotherapy can cause side effects like bleeding and fatigue. It also increases your risk of infection. Your doctor will help you manage most of the side effects during treatment.

• Chemotherapy drugs travel through your body to reach cancer cells. Most drugs do not get into your brain or spinal cord. If you have leukemia there, you may need an injection into fluid surrounding your spinal cord. The name for this is intrathecal chemotherapy, and it delivers the highest possible dose of chemotherapy to the central nervous system.

• You may need to take more than one drug. You also may need more than one course of treatment. For instance, for acute lymphocytic leukemia—one of the most common types—doctors typically give three drugs in three treatment phases. It can take about two years to complete the treatment.

Sometimes it takes high doses of chemotherapy to treat leukemia. But, high doses can destroy the spongy center of your bones, called bone marrow. Damage to bone marrow can lead to severe infections and bleeding. Stem cell transplant uses high doses of chemotherapy followed by replacement of bone marrow cells, called stem cells. These cells will grow into the blood cells you need to prevent infection and bleeding.

Stem cells can come from blood or bone marrow. Most people with cancer get them from a blood donor who matches their tissue type. The name for this treatment is an allogenic transplant.

Stem cell transplant is a difficult treatment. It's best to have this done at a hospital with experience in treating leukemia. Before deciding on a stem cell transplant, talk with your doctor about all the risks and benefits.

Radiation therapy uses high energy X-rays to kill cancer cells. Like chemotherapy, it also kills some normal cells and can cause similar side effects. You may need this treatment if:

• You have leukemia that has spread to your brain or spinal cord.

• You are having a stem cell transplant. Your doctors may use radiation before the transplant to kill cancer cells.

• You have a leukemia tumor in your chest. Radiation therapy can shrink the tumor to improve breathing.

• You have bone pain from leukemia. Radiation therapy may reduce the pain.

Surgery is not a common treatment for leukemia. However, you may need surgery to remove a lymph node as part of your diagnosis. You may also need surgery if leukemia has invaded your spleen. If you have chronic lymphocytic leukemia, your spleen may get large enough to require surgery to remove it. Removing your spleen may improve some leukemia symptoms.

Targeted therapies for leukemia are not the same as chemotherapy or radiation. These treatments specifically target molecules on leukemia cells to destroy the cells or block their growth. Targeted therapy is only recommended for specific types of leukemia. People who have targeted treatment often have fewer side effects. Your doctor may do blood tests to see if you could benefit from this treatment.

Here are some examples to ask about:

• If you have acute lymphocytic leukemia or chronic myeloid leukemia, you may have a chromosome abnormality called Philadelphia chromosome. Tyrosine kinase inhibitors are drugs that target this defect. These drugs are pills you would take daily.

• Immunotherapy is a type of treatment that uses man-made antibodies to help your body’s immune system fight leukemia. These drugs have approval for treating some types of acute lymphoblastic leukemia and acute lymphocytic leukemia.

• Immunotherapy is an active area of research. Ask your doctor if you might benefit from participating in a clinical trial for immunotherapy. Adoptive cell therapy is one type under study. It removes specific immune cells from your blood. The cells are sent to a laboratory, where they are modified to be stronger and more effective cancer-fighting immune cells. Then, they are multiplied and put back in your blood. The modified cells are able to identify and destroy cancer cells.

There are many options for treating leukemia. Talk with your doctor about what options would be best for you and your type of leukemia.