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LeukemiaTreatment OptionsThe treatment approach differs from patient to patient, from one leukemia type to another, and from a leukemia stage or phase to another. There are a certain number of factors that influence the treatment approach: - The leukemia type Leukemia treatment options include chemotherapy, targeted therapy, biological therapy, radiation therapy, stem cell transplantation or bone marrow transplants, and surgery (for a splenectomy). Chemotherapy: Most of the patients that suffer from leukemia receive chemotherapy and targeted therapy (see below). Chemotherapy is a systemic treatment (affects cells throughout the entire body) that uses drugs either to stop the abnormal growth and dividing process of the leukemia cells, or to kill the leukemia cells. This type of treatment can be administered as a single drug or in combination with other drugs. Chemotherapy can be given in several forms:
The advantage of this last type of treatment approach is that the drugs travel on a direct path from the brain and spinal cord to the leukemia cells. Usually, chemotherapy is administered in cycles where a treatment period is followed by a break period. The purpose of this treatment is to achieve a complete remission. The remission refers to the phase when leukemia signs and symptoms disappear, the leukemia cells are destroyed, and normal cells grow in the bone marrow. However, in the remission stage the cancer is not completely cured, but the leukemia cells do not show up in the blood and bone marrow.
Targeted Therapy Targeted therapy is a broad-based term used to describe a new class of drugs that seek to stop or inhibit the growth (dividing process) of new cancer cells by interfering with specific molecules that "signal" for new cancer cells to grow and develop. Since targeted therapy drugs are directed only at the molecules that "allow" the process of creating cancer cells, they generally do not harm healthy cells in the way that chemotherapy and radiation does, and is generally considered less harmful with side-effects than chemotherapy and radiation. Other names used to describe this class of drugs includes molecularly targeted drugs, and moleculary targeted therapies. Targeted therapy drugs are used alone or in combination with chemotherapy drugs to maximize results. They are also divided up between first-line and second-line treatment consideration. First line treatment for cancer means that specific drugs, or a combination of drugs, is used in the initial round or course of treatment, before any other drug or combination of drugs is tried. Second-line treatment means that a specific drug, or combination of drugs, is used after first-round treatment was tried and failed, yielded poor results, produced side-effects considered too severe, and when a cancer has reappeared after remission. Optimism over this new line of cancer drugs should be curbed since not all "targeted therapy drugs" turn out to be beneficial. Gemtuzumab ozogamicin (Mylortag®) was pulled from pharmacy shelves in the summer of 2010 by Pfizer after a closer look by the FDA revealed the drug offered no benefit when used with chemotherapy drugs, and after a greater number of deaths occurred in the group of patients who received Mylotarg compared with those receiving chemotherapy alone. FIRST-LINE treatment targeted therapy drugs for leukemia include. Imatinib (Gleevec®) is used to treat:
With this drug, more than 90% of patients will be able to keep CML in check for at least five years, reducing it to a chronic, manageable condition in that time. Gleevec is considered to be one of the most successful examples of targeted therapy, available today. It works by blocking the action of the abnormal protein that signals cancer cells to multiply. Gleevec, approved in 2001, was one of the first targeted therapy drugs to come out and is one of the most widely used since it is also used to treat gastrointestinal stromal tumors (GISTS). Ninety percent of all chronic myelogenous leukemia cases involving the Philadelphia chromosome. Nilotinib (Tasigna®) is used as a first line treatment to treat chronic myelogenous leukemia (CML) that is Philadelphia chromosome positive. Early results of an on-going 5 year study revealed in December, 2010, show that Tasigna might be superior to the popular Gleevec for treating CML patients. Tasigna cut the amount of a tell-tale protein in the blood in three times as many patients with leukemia as did it's predecessor, Gleevec. In a Bloomberg story stemming from press release issued by the drug's maker, the company reported: "In the clinical trial, designed to follow about 900 patients for five years, almost three times more people taking 300 milligrams of Tasigna twice daily had only a trace amount of the Bcr-Abl protein in their blood after 24 months. The other patients took either 400 milligrams of Gleevec once a day or 400 milligrams of Tasigna twice a day." Tasigna is mabe by Novartis, the same company that created Gleevec. Novartis considers Tasigna the superior successor to Gleevec, whose patent runs out in 2015. The down-side of Tasigna is that it carries a black box warning from the FDA for an irregular heart rhythm (QT prolongation) that can lead to fainting, loss of consciousness, seizures, or sudden death. Even with this warning, the FDA granted Tasigna first-line treatment status for Philadelphia chromosome-positive chronic myeloid leukemia in the chronic phase in June, 2010. Dasatinib (Sprycel®) was once the go to drug when Gleevec and other types of medications don't work initially, no longer work, or are not administered due to their severe side-effects, but is now a first-line treatment drug for CML. Sprycel is used to treat:
Sprycel works the same way as Gleevec, by blocking the action of an abnormal protein that tells cancer cells to multiply. Sprycel received first-line treatment status for CML-Philadelphia chromosome by the FDA in October, 2010. SECOND-LINE treatment targeted therapy drugs for leukemia include: Tretinoin (Vesanoid®) is used to treat acute promyelocytic leukemia in patients who did not benefit from other types of chemotherapy, or whose condition improved with other types of chemotherapy, but then got worse. Tretinoin is used to produce remission (a decrease or disappearance leukemia symptoms ) in APL, however, other medications must be used after treatment with tretinoin to prevent the cancer from returning. Vesanoid comes with an FDA warning for a group of symptoms related to its main ingredient which is a type of Vitamin A. Rituximab (Rituxan®) is used in combination with other drugs (primarily the chemo drug fludarabine) to treat B-cell chronic lymphocytic leukemia, including hairy cell leukemia (a subtype of CLL). Rituxan comes with an FDA warning that oncologists make aware to their patients. Alemtuzumab (Campath®) is used to treat B-cell chronic lymphocytic leukemia (B-CLL) after a chemotherapy drug called fludarabine has failed. Campath comes with an FDA warning that patients will be informed about. Ofatumumab (Arzerra®) is approved by the Food and Drug Administration (FDA) to treat chronic lymphocytic leukemia (CLL) in adults that have not gotten better with a chemotherapy/targeted drug therapy involving fludarabine (chemo), and alemtuzumab (targeted). Biological Therapy or Immunotherapy: This is another new type of leukemia treatment used to improve the body’s natural defenses. This treatment uses the body’s immune system either to fight against cancer, or to decrease the side effects caused by the cancer treatment. Biological therapy is administered as an injection into the vein. This treatment is used in patients with chronic lymphocytic leukemia and chronic myeloid leukemia. In the first case (chronic lymphocytic leukemia patients), the doctor administers a monoclonal antibody that attaches to the leukemia cells in the blood and bone marrow, and allows the immune system to kill them. In the second case (chronic myeloid leukemia patients) the doctor administers a natural substance called interferon which slows down the growth process of leukemia cells. Biological therapy side effects vary from patient to patient depending on the substance used. The most common side effects include:
Radiation Therapy or Radiotherapy: Radiation therapy is a cancer treatment which uses high-energy rays or particles to destroy cancerous cells (leukemia cells). Leukemia patients can receive either an external radiation therapy where several organs like the spleen, brain, or other organs where leukemia cells have been collected in, are radiated, or total-body irradiation where the body is irradiative through a bone marrow transplant. The radiation therapy side effects include:
Stem Cell Transplantation or Bone Marrow Transplant: This is a treatment option for some leukemia patients. During this procedure, the patient receives healthy bone marrow cells from a donor, either yourself as a donor or someone else. A bone marrow transplant involves two steps. First, the patient undergoes a treatment with radiation or chemotherapy which kills the abnormal bone marrow. Second, the patient will receive, through a procedure similar with a blood transfusion, healthy stem cells. The stem cells enter the body through a catheter inserted into a large vein from the neck or chest area. These healthy stem cells will allow healthy new blood cells to develop. There are several types of stem cell transplantations classified according to two criteria: A) The “organ donor” from where the stem cells are removed. There are three types of transplants: 1) Bone marrow transplantation: This type of
transplant uses stem cells from the bone marrow. B) The “human donor” who provides the stem cells. According to this criteria, there are also three types of transplant: 1) Autologous stem cell transplantation: This
type of transplant uses the patient’s own stem
cells. In this case, the stem cells are removed from the
patient's blood or bone marrow, and treated in order to
kill leukemia cells. Sometimes, these stem cells are
frozen until they are used for a transplant. Like every treatment, stem cell transplantation has a certain number of side effects. These include:
Surgery: The only type of surgery used as a treatment option for leukemia is splendectomy (the surgical removal or the spleen), an alternative used when the spleen has colleted a high amount of leukemia cells, and its swelling causes an increased level of discomfort for the patient.
Article by Alina Morrow, MS Sources:
Leukemia is sometimes misspelled as lukemia or luekemia. Page Covers: What is the treatment for Leukemia? How is treated? |
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Page Last Modified:
12/25/2010
