Acute leukemia - Treatment

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Acute leukemia - Treatment
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Due to the aggressive and rapid nature of acute leukemia, treatment will usually begin a few days after a diagnosis has been made.
Deciding on a treatment plan

Once leukemia has been detected, you will need to discuss possible treatment plans. It is likely that the discussion will take place with several doctors, and other health professionals, who each specialize in different aspects of treating leukemia. These health professionals make up what is known as a multi-disciplinary team (MDT).

A MDT will often include:

* a haemato-oncologist (a specialist in the non-surgical treatment of leukemia using techniques such as chemotherapy),
* a haemato-pathologist (a specialist in the study of cancerous blood cells),
* a pharmacist ,
* a social worker ,
* a transplant specialist ,
* a microbiologist (a specialist in infectious diseases)
* a psychologist ,
* a specialist cancer nurse, and
* a counselor .

The initial treatment for acute leukemia usually takes place in a specialist center, or hospital. If you live in a large urban area, such as London, it is likely that appropriate facilities will be nearby. If you live in a smaller town, or in the countryside, you may have to be treated in a specialist center in another part of the country.

If your child has leukemia, and needs to be treated at specialist center that is not near your home, arrangements can be made that will allow you to stay with your child for some, or all, of their treatment.

The recommended treatment plan will depend on your general health and your age because many of the treatments can cause serious side effects and complications that can put a tremendous strain on the body. Children, teenagers, and adults who are in good health are usually able to withstand an aggressive treatment regime aimed at curing the leukemia.

Older people with acute leukemia, or those in poor health, are unlikely to survive such an aggressive approach to treatment. It may therefore be possible to achieve a remission in symptoms, but it may not be possible to cure the leukemia.

There are several factors that you will need to take into account when deciding on your treatment. They include:

* your age,
* the likely progression of your leukemia,
* the extent of your leukemia, and
* the possible side-effects of treatment.

You will not be rushed into you into making a decision about your treatment plan and, before deciding, you should feel free to talk to as many people as you want, including friends, family, and your partner.

Many people find that writing a list of questions at home to ask the MDT is helpful. Your MDT will be able to recommend what they feel are the best treatment options but, ultimately, the decision will be yours.
Stages of treatment

Treatment for acute leukemia is carried out in phases. These are described below.

* Induction - the initial stage of treatment aims to kill the leukemia cells in your bone marrow, restore your blood to proper working order, and resolve any symptoms that you may have.
* Consolidation - this stage aims to kill any remaining leukemia cells that may be present in your central nervous system.
* Maintenance - this final stage involves taking regular doses of chemotherapy tablets in order to prevent the leukemia returning.

Maintenance is not usually used in the treatment of acute myeloid leukemia (AML) because it only seems to be effective in the treatment of acute lymphoblastic leukemia (ALL).
Induction

The induction stage of treatment will need to be carried out in hospital, or in a specialist center. This is because you will probably require regular blood transfusions as it is likely that your blood will not have enough healthy blood cells.

You will also be vulnerable to infection so it is important that you are in a sterile environment where your health can be carefully monitored and any infection can be promptly treated. You may also be given antibiotics to further prevent any infection.

You will be given a combination of chemotherapy medication in order to kill the leukemia cells in your bone marrow. As you will need to receive many medicines as part of your treatment, a tube will be inserted into a large vein near your heart. This is known as a central line. Having a central line means that you will not have to undergo many painful injections.

Some chemotherapy medication may also be directly administered into your cerebrospinal fluid in order to kill any leukemia cells that may have spread to your nervous system. These are administered by way of a needle that is placed into your spine, in a similar way to a lumbar puncture.

Side-effects from chemotherapy are common. They can include:

* nausea,
* vomiting,
* diarrhea,
* loss of appetite,
* mouth ulcers,
* tiredness,
* skin rashes,
* infertility, and
* hair loss.

The side-effects should resolve once treatment has finished. Your hair will normally take between 3-6 months to grow back.

If you have the sub-type of AML known as acute promyelocytic leukemia, you will also be given a medicine called all-trans retinoic acid, or ATRA. ATRA works by changing the immature blast cells into mature healthy blood cells.

Side-effects of ATRA include:

* headaches,
* dry mouth and skin,
* nausea,
* bone pain, and
* dry eyes.

If you have the sub-type of ALL, known as Philadelphia chromosome positive ALL, you will also be given a medicine called imatinib. Imatinib works by blocking the signals in the cancerous cells that cause them to grow and reproduce. This kills the cancerous cells.

Imatinib is taken orally (as a tablet). The side-effects of imatinib are usually mild and should improve with time. They include:

* nausea,
* vomiting,
* swelling in the face and lower legs,
* muscle cramps,
* rash, and
* diarrhea.

The induction phase of treatment can last from two weeks to several months, depending on how well you respond to treatment. In some cases, you, or your child, may be able to leave hospital and receive treatment on an out-patient basis if symptoms improve.
Consolidation

Leukemia can return if only one cancerous cell remains in your body. So the aim of consolidation treatment is to ensure that any remaining leukemia cells are killed.

Treatment involves receiving regular injections of chemotherapy medications. This is normally done on an out-patient basis, which means that you will not have to stay in hospital overnight. However, you may require some short stays in hospital if your symptoms suddenly worsen, or if you develop an infection.

The consolidation phase usually lasts several months.
Maintenance

The maintenance phase is designed to act as further insurance against the possibility of the leukemia returning. It involves taking regular doses of oral chemotherapy medications (tablets) while undergoing regular check-ups to monitor how effective your treatment is proving.

The maintenance phase usually lasts for two years. It is not usually used in the treatment of AML because the evidence shows that taking regular oral chemotherapy medication has little effect in preventing a relapse of AML.
Bone marrow and stem cell transplantation

If you, or your child, do not respond to chemotherapy, a possible alternative treatment option is bone marrow, or stem cell, transplantation.

Before transplantation can take place, the person receiving the transplant has to undergo aggressive high-dose chemotherapy and radiotherapy in order to destroy any cancerous cells in their body. This can put enormous strain on the body and cause significant side-effects and potential complications.

Transplantations have better outcomes if the donor has the same tissue type as you, or your child. Usually, the best candidate to provide a donation is a brother or sister with the same tissue type.

Due to these issues, transplantations are usually only successful when they are carried out in children and young people, or older people who are in good health, and when there is a suitable donor, such as a brother, or sister.
Clinical trials

A number of clinical trials are currently underway which aim to find the best way of treating acute leukemia. Clinical trials are studies that use new and experimental techniques to see how well they work in treating, or possibly curing, acute leukemia.

However, you should be aware that there is no guarantee that the techniques that are being studied in the clinical trial will be effective.

The healthcare professionals who are responsible for your treatment and care will be able to let you know if there are any available clinical trials in your area, as well as explaining the benefits and risks involved.

Wellsphere does not provide medical advice, diagnosis or treatment.

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