Your doctor and healthcare team will recommend a treatment plan for you based on the type of leukemia and subtype that you have, your age and other aspects of your health. The most common treatment approaches for leukemia are chemotherapy, radiation therapy, biologic therapy and stem cell transplant, all of which are offered at Seattle Cancer Care Alliance.
The goal of treating leukemia is to put the disease into complete remission, which means you have no sign of leukemia in your body and you have returned to good health. For more and more patients, treatments today are putting the disease into remission for at least five years.
If you have acute myelogenous leukemia (AML), your treatment will begin right away in the hospital, where you’ll receive chemotherapy to put your leukemia into remission. This is called induction therapy. The idea is to kill a maximum number of blood cancer cells to induce a remission, or absence of signs or effects of the disease, together with normal blood counts. After you are in remission, you’ll likely receive more inpatient treatment, called consolidation therapy, to kill off any remaining cancer cells. You may receive chemotherapy with or without an allogeneic stem cell transplant or radiation therapy, and for a particular subtype of AML, there are drugs that keep leukemia cells from dividing or that help them mature into white blood cells.
Immunotherapy is currently being tested in clinical studies. This involves using medications to help boost your own immune system to fight off the leukemia cells.
Similar to treatment for AML, acute lymphocytic leukemia (ALL) patients receive two phases of treatment: induction therapy to kill a maximum number of ALL cells, and maintenance therapy to keep you in remission. If you have ALL, you’ll likely also receive treatment for the central nervous system (brain and spinal cord), where ALL cells frequently “hide out” during initial treatments because chemotherapy often cannot reach the brain and spinal cord.
Other treatments include stem cell transplant, biologic therapy (boosting your own immune system), and anticancer drugs called tyrosine kinase inhibitors that treat some types of adult ALL. These drugs block the enzyme, called tyrosine kinase, that causes stem cells to develop into more white blood cells than the body needs. Two of the drugs used are imatinib mesylate (Gleevec®) and dasatinib (Sprycel®).
Patients with chronic myeloid leukemia (CML) begin treatment with imatinib mesylate (Gleevec), which blocks the abnormal protein that causes your body to make more and more leukemic cells. As a result, Gleevec helps to bring your levels of blood cells back to normal. Almost all people with CML get some benefit from Gleevec. This drug, taken by mouth, is not the same as chemotherapy. It has little to no effect on healthy tissues, so it has less severe side effects than chemotherapy. Still, it is not entirely side-effect free. Your doctor can give you details about how Gleevec may affect you. It does not cure CML, but it keeps CML under control for many patients for as long as they take it. Other drugs, such as dasatinib, are used for certain patients instead of Gleevec.
High-dose chemotherapy along with a bone marrow transplant is the only treatment that can cure CML at this time. This treatment is most successful in younger patients, but people up to 60 years of age who have a matched donor may be considered for this treatment as well.
Bone marrow transplantation can be a high-risk procedure. Studies are under way to see whether CML patients have better long-term outcomes with drug therapy or with transplantation.
Some people with chronic lymphocytic leukemia (CLL) will not need treatment for long periods of time after diagnosis. Patients who do need treatment may receive chemotherapy or monoclonal antibody therapy alone or in combination. Bone marrow transplantation is also a treatment option for certain people with CLL.