Leukemia Treatment Options

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.

Watchful Waiting

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.

Chemotherapy

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.

Targeted Therapy

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.

Biological Therapy

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.