How is leukemia treated?
Treatments for leukemia depend on the type of leukemia you have, your age and overall health, and if the leukemia has spread to other organs or tissues. There are five common treatment categories. They include:
- Chemotherapy: Chemotherapy are chemicals (medications) given in pill form, administered through an IV into a vein or a central line or given in shots under the skin (subcutaneously). The chemicals kill leukemia cells or stop them from dividing. Usually a combination of chemotherapy drugs are used. This is the most common form of treatment for leukemia. Treatment consists of cycles – a certain number of days of treatment are followed by days of rest to allow the body to recover. The length of time for treatment can vary by regimen ranging from six months to indefinite treatment.
- Radiation therapy: This treatment uses strong beams of energy to kill leukemia cells or stop them from growing. Radiation is directed to exact sites in your body where there is a collection of cancer cells or can be given over your whole body as part of a hematopoietic cell transplant (see below).
- Immunotherapy: This treatment, also called biologic therapy, uses certain drugs to boost your body’s own defense system – your immune system – to fight leukemia. Immunotherapies include interferon, interleukins and CAR-T cell therapy.
- Targeted therapy: This treatment uses drugs that are focused on a specific features of leukemia cells. Targeted therapies work by blocking the ability of leukemia cells to multiply and divide, cutting off the blood supply needed for the cells to live, or killing the cells directly. Targeted therapy is less likely to harm normal cells. Examples of targeted therapy include monoclonal antibodies (such as inotuzumab [Besponsa®], gemtuzumab, [Mylotarg®], rituximab [Rituxan®], ofatumumab [Arzerra®], obinatuzumab [Gazyva®, Gazyvaro®], alemtuzumab [Campath®, MabCampath®]) and tyrosine kinase inhibitors (such as imatinib [Gleevec®], dasatinib [Sprycel®], nilotinib [Tasigna®], ponatinib [Iclusig®]), ruxolitinib [Jakafi®], fedratinib [Inrebic®], gilteritinib [Xospata®], midostaurin [Rydapt®], ivositinib [Tibsovo®], ibrutinib [Imbruvica®], venetoclax [Venclexta®]).
- Hematopoietic cell transplant (also known as stem cell or bone marrow transplant): This procedure replaces the cancerous blood-forming cells that have been killed by chemotherapy and/or radiation therapy with new, healthy hematopoietic cells. These healthy cells are taken from you (before exposure to chemo or radiation therapy) or from a donor’s blood or bone marrow and are infused back into your blood. Healthy hematopoietic cells grow and multiply forming new bone marrow and blood cells that develop into all the different types of cells your body needs (red blood cells, white blood cells and platelets). In the case where the cells are taken from a different person (donor), the new immune system recognizes the cancer cells as foreign and kills them (similar to other immunotherapies).
Note: A treatment plan will be developed specifically for you. Several of the treatment methods described above will be a part of your treatment plan. Your treatment depends on your age, overall health, type of leukemia and other unique features of the leukemia, response to initial treatment and many other factors. Your healthcare team will determine a treatment plan they hope will be most successful for you.
What are the stages of leukemia treatment?
Some leukemia treatment is delivered in three phases. Each phase has a specific goal.
- Induction therapy is the first phase. Its goal is to kill as many leukemia cells as possible in the blood and bone marrow to achieve remission. In remission, blood cell counts return to normal levels, no leukemia cells are found in the blood and all signs and symptoms of disease are gone. Induction therapy usually lasts four to six weeks.
- Consolidation (also called intensification), the second phase, begins after leukemia is in remission. The goal of this phase is to kill any remaining undetected leukemia cells in the body so the cancer does not return. Consolidation therapy is usually given in cycles over four to six months.
- Maintenance therapy is given to kill any leukemia cells that may have survived the first two treatment phases. The goal of maintenance therapy is to prevent the return of leukemia (relapse). Treatment usually lasts for about two years.
(Treatment can be also directed at the brain and spinal cord [the central nervous system] during each of these phases. This is done to kill cancer cells that hide in these areas of the body where the chemotherapy cannot reach. These “hidden” cancer cells are a reason leukemia comes back or relapses.)
Other leukemia treatments do not have phases and are given indefinitely. They are continued as long as they are working to combat the leukemia and the patient is tolerating the treatment well.
Treatment is resumed or changed if leukemia comes back or relapses.