Acute Lymphocytic Leukemia

Management

On-going medical care after leukemia treatment is very important. Regular visits with your doctor are needed for many years following treatment to verify that the treatment was effective and check for any side effects from treatment.

New symptoms should be reported to your doctor right away so that a recurrence of leukemia or side effects can be treated. Recurrence of cancer after treatment is not unusual, but further treatment can sometimes put your cancer back into remission. Side effects from leukemia treatment can be short term, lasting a few weeks after treatment, or linger for several months—or may even be permanent.

A routine follow-up visit will include discussing your current health and any symptoms you feel with your doctor and a physical exam. Blood samples will be collected and bone marrow aspirations or medical imaging will be performed as necessary depending on your medical history and the results of your physical exam.

This section contains more information on:
• Recurrence of leukemia
• Emotional well-being
• Hospice care

Recurrence of leukemia

A recurrence is when the leukemia goes into remission after treatment and then comes back. For many people with recurrence, the leukemia can go back into remission with additional treatment. A blood and bone marrow transplant is often considered for recurrent leukemia. However, secondary remissions are often temporary.

If the leukemia continues to recur or persist after subsequent treatments, you and your doctor will have to weigh the possible benefits of additional treatments with potential side effects. Your doctor may recommend focusing treatment on relieving the symptoms of the leukemia.

In these circumstances, less intensive chemotherapy may be undertaken to slow the growth of the leukemia instead of trying to eradicate it. Treatment therapies usually focus on controlling pain, fatigue, depression, nausea, and loss of appetite. Blood transfusions may be undertaken to minimize fatigue. Continued growth of leukemia in the bone marrow can be very painful. Narcotics may be necessary if other medications do not alleviate the pain. Other medications may be prescribed to minimize symptoms such as fatigue, depression, nausea, and loss of appetite.

Emotional well-being

After treatment, most people feel relieved to be done and excited to return to their normal routine but worried about the uncertainty of their health. It can take weeks to months before the recovery feels real and a person gains confidence in his or her own health. However, it can be very challenging to live with the uncertainty that accompanies most forms of cancer.

Although the road ahead may not be easy and is full of uncertainties, it's important to remember that you're not alone. There are many resources available to help, and here are some strategies to use them:

• Take an active role in your healthcare. Find out everything you can about the type, the stage, the treatment options, and their side effects. Although you may feel tired and discouraged, don't let others, including your family or your doctor, make important decisions for you. Talk with your doctor and seek out information from reliable sources.

• Maintain a strong support system. Don't be afraid to ask for help with coping with the issues, pain, or anxieties of leukemia. Support can come in many forms: family, friends, individual counselors, cancer support groups, church or spiritual groups, or online support communities. Although support groups aren't for everyone, they can be a good source for practical information. The concern and understanding of others coping with cancer can be especially helpful. You may also find you can develop deep and lasting bonds with people who are experiencing the same things you are.

• Stay active and set reasonable goals. Leukemia doesn't mean you need to stop doing the things you enjoy or normally participate in. Setting reasonable goals can help you maintain a sense of accomplishment and a sense of purpose in life. You may not be able to work or volunteer for 40 hours a week, for example, but you may be able to work or volunteer part time. Many people find professional or volunteer work integral to their sense of well-being and a positive mental attitude.

• Make healthful choices. Eating well, exercising regularly, relaxing and getting enough rest are fundamental for your physical and emotional well-being. Plan ahead for the downtimes when you may need to rest more or limit what you do to combat the stress and fatigue of leukemia. One of the best things you can do for your body is to develop healthful eating and exercise habits after treatment. This can be challenging because of side effects of treatment of leukemia, but you will be surprised at the long-term benefits of eating healthfully and exercising regularly.

Hospice care

Hospice is a centuries-old idea of offering a place of shelter and rest to weary and sick travelers on a long journey. The term "hospice" was first used to mean providing specialized care for dying patients in 1967 by Dame Cicely Saunders at St. Christopher's Hospice in London.

Today, hospice is a philosophy of healthcare that provides humane and compassionate care for people in the last phases of incurable disease. Hospice affirms life and does not hasten or postpone death. The philosophy recognizes death as the final stage of life and seeks to allow patients to continue an alert, pain-free life so that their last days may be spent with dignity and quality, surrounded by their loved ones.

Hospice care is usually undertaken when the patient can no longer benefit from curative treatment. The patient, patient's family, and doctor decide together when hospice services should begin. Usually this is when the patient's life expectancy is thought to be six months or less. Hospice care is provided 24 hours a day, seven days a week in the patient's home, a hospital, nursing home, or private hospice facility. Most hospice care in the United States occurs in the home, with a family member or members serving as the main hands-on caregiver. Hospice can bring hope for a quality of life during the advanced stage of leukemia.