Leukemia : Chemotherapy, Biological and Radiation Therapy, Stem Cell

by National Cancer Institute

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Chemotherapy

Most patients with leukemia receive chemotherapy. This type of cancer treatment uses drugs to kill leukemia cells. Depending on the type of leukemia, the patient may receive a single drug or a combination of two or more drugs.

People with leukemia may receive chemotherapy in several different ways:

• By mouth

• By injection directly into a vein (IV or intravenous)

• Through a catheter (a thin, flexible tube) placed in a large vein, often in the upper chest - A catheter that stays in place is useful for patients who need many IV treatments. The health care professional injects drugs into the catheter, rather than directly into a vein. This method avoids the need for many injections, which can cause discomfort and injure the veins and skin.

• By injection directly into the cerebrospinal fluid - If the pathologist finds leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord, the doctor may order intrathecal chemotherapy. The doctor injects drugs directly into the cerebrospinal fluid. This method is used because drugs given by IV injection or taken by mouth often do not reach cells in the brain and spinal cord. (A network of blood vessels filters blood going to the brain and spinal cord. This blood-brain barrier stops drugs from reaching the brain.)

Patients receive chemotherapy in cycles: a treatment period, then a recovery period, and then another treatment period. In some cases, the patient has chemotherapy as an outpatient at the hospital, at the doctor's office, or at home. However, depending on which drugs are given, and the patient's general health, a hospital stay may be necessary.

Some people with chronic myeloid leukemia receive a new type of treatment called targeted therapy. Targeted therapy blocks the production of leukemia cells but does not harm normal cells. Gleevec, also called STI-571, is the first targeted therapy approved for chronic myeloid leukemia.

Biological Therapy

People with some types of leukemia have biological therapy. This type of treatment improves the body's natural defenses against cancer. The therapy is given by injection into a vein.

For some patients with chronic lymphocytic leukemia, the type of biological therapy used is a monoclonal antibody. This substance binds to the leukemia cells. This therapy enables the immune system to kill leukemia cells in the blood and bone marrow.

For some patients with chronic myeloid leukemia, the biological therapy is a natural substance called interferon. This substance can slow the growth of leukemia cells.

Patients may want to ask these questions about chemotherapy or biological therapy:

• Why do I need this treatment?
• What drugs will I get?
• Should I see my dentist before treatment begins?
• What will the treatment do?
• Will I have to stay in the hospital?
• How will we know the drugs are working?
• How long will I be on this treatment?
• Will I have side effects during treatment? How long will they last? What can I do about them?
• Can these drugs cause side effects later on?
• How often will I need checkups?

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill leukemia cells. For most patients, a large machine directs radiation at the spleen, the brain, or other parts of the body where leukemia cells have collected. Some patients receive radiation that is directed to the whole body. (Total-body irradiation usually is given before a bone marrow transplant.) Patients receive radiation therapy at a hospital or clinic.

These are some questions a person may want to ask the doctor before having radiation therapy:

• Why do I need this treatment?
• When will the treatments begin? How often will they be given? When will they end?
• How will I feel during therapy? Will there be side effects? How long will they last? What can we do about them?
• Can radiation therapy cause side effects later on?
• What can I do to take care of myself during therapy?
• How will we know if the radiation is working?
• Will I be able to continue my normal activities during treatment?
• How often will I need checkups?

Stem Cell Transplantation

Some patients with leukemia have stem cell transplantation. A stem cell transplant allows a patient to be treated with high doses of drugs, radiation, or both. The high doses destroy both leukemia cells and normal blood cells in the bone marrow. Later, the patient receives healthy stem cells through a flexible tube that is placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.

There are several types of stem cell transplantation:

Bone marrow transplantation — The stem cells come from bone marrow.

Peripheral stem cell transplantation — The stem cells come from peripheral blood.

Umbilical cord blood transplantation — For a child with no donor, the doctor may use stem cells from umbilical cord blood. The umbilical cord blood is from a newborn baby. Sometimes umbilical cord blood is frozen for use later.

Stem cells may come from the patient or from a donor:

Autologous stem cell transplantation — This type of transplant uses the patient's own stem cells. The stem cells are removed from the patient, and the cells may be treated to kill any leukemia cells present. The stem cells are frozen and stored. After the patient receives high-dose chemotherapy or radiation therapy, the stored stem cells are thawed and returned to the patient.

Allogeneic stem cell transplantation — This type of transplant uses healthy stem cells from a donor. The patient's brother, sister, or parent may be the donor. Sometimes the stem cells come from an unrelated donor. Doctors use blood tests to be sure the donor's cells match the patient's cells.

Syngeneic stem cell transplantation — This type of transplant uses stem cells from the patient's healthy identical twin.

After a stem cell transplant, patients usually stay in the hospital for several weeks. The health care team protects patients from infection until the transplanted stem cells begin to produce enough white blood cells.

These are some questions a person may want to ask the doctor before having a stem cell transplant:

• What kind of stem cell transplant will I have? If I need a donor, how will we find one?
• How long will I be in the hospital? What care will I need when I leave the hospital?
• How will we know if the treatment is working?
• What are the risks and the side effects? What can we do about them?
• What changes in normal activities will be necessary?
• What is my chance of a full recovery? How long will that take?
• How often will I need checkups?

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