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Treatment Overview
Unlike other cancers, leukemia does not involve a tumor that can be surgically removed; it originates in the bone marrow. The bone marrow cannot be removed because it occupies the center of all the major bones and produces the blood cells that are needed by the rest of the body. Therefore, the treatment of leukemia focuses on destroying the abnormal leukemia cells.
The goals of leukemia treatment are to bring about a remission and to prevent a relapse. Remission is when the signs and symptoms of the cancer disappear; however, the cancer may still be in the body. A complete remission, when no signs or symptoms are apparent for a period of years, is considered a cure. The reappearance of the signs and symptoms after a remission is called a relapse. If a relapse occurs, further treatment can sometimes successfully bring about subsequent remissions.
The treatment for acute lymphocytic leukemia involves three phases that usually take between 2½ to 3½ years to complete. The intensity of the treatment and types of therapies used will vary depending upon the immunophenotype and chromosomal abnormalities present, your age, white blood cell count at the time of diagnosis, your overall health, and whether the leukemia involves other organs in your body.
The goal of the first phase of treatment, induction therapy, is to kill the abnormal blood cells. This usually requires at least four weeks of chemotherapy. Patients with ALL need to begin induction therapy as soon as possible after their diagnosis.
During consolidation therapy, the second phase, the treatment is aimed at eliminating any lingering leukemia cells in the spinal cord or brain. Radiation therapy is a crucial component to treatment during this phase to reduce the risk of a relapse.
The final treatment phase known as maintenance therapy involves much lower doses of therapies designed at preventing leukemia cells from reforming.
Children with ALL usually receive additional therapy targeted at killing abnormal cells in the central nervous system during each phase of treatment. This treatment is called central nervous system sanctuary therapy, central nervous system preventive therapy, or intrathecal chemotherapy. This therapy involves injecting chemotherapy directly into the spinal cord fluid. These direct injections kill cancer cells that can't be reached by chemotherapy drugs given by mouth or through an intravenous line.
Supportive care is an important component of leukemia treatment. Supportive care can be as simple as proper diet and extra sleep or can involve medications to control the pain and side effects of treatment. Typically, the best outcomes occur when you and your doctor work together to develop a treatment strategy that satisfies your individual needs. A clear understanding of your condition and clear communications with your doctor can help ensure that you are receiving the best possible treatment and supportive care.
This section contains more information on:
• Questions to ask
• Chemotherapy
• Kinase inhibitors
• Biological therapy: monoclonal antibodies
• Radiation therapy
• Blood and bone marrow transplant
• Experimental therapy
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