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Leukemia treatment falls into two categories: treatment to fight the cancer and treatment to relieve the symptoms of the disease and the side effects of the treatment (supportive care). The goal of treatment for leukemia is to bring about a complete remission. Unlike other types of cancer, leukemia is not a solid tumor that a doctor can surgically remove. The source of the problem is in the bone marrow, and bone marrow cannot be removed. Treatment for leukemia is complex, depending on many factors including age and overall health, the type of leukemia, and whether it has spread to other parts of the body. In general, there are five major approaches to the treatment of leukemia: chemotherapy to kill leukemia cells using strong anti-cancer drugs; interferon therapy to slow the reproduction of leukemia cells and promote the immune system's anti-leukemia activity; radiation therapy to kill cancer cells by exposure to high-energy radiation; stem cell transplantation (SCT) to enable treatment with high doses of chemotherapy and radiation therapy; and surgery to remove an enlarged spleen or to install a venous access device (large plastic tube) to give medications and withdraw blood samples. Chemotherapy: Chemotherapy uses drugs to destroy cancer cells. These drugs can be given intravenously (IV, through a vein), orally (by mouth), subcutaneously (SubQ, or injected under the skin), intramuscularly (injected into muscle), or intrathecally (injected into cerebrospinal fluid). Chemotherapy used to treat leukemia varies, because there are many different forms of this disease. In general, leukemia treatment combines chemotherapy with a number of different anticancer drugs, which destroy cancer cells by preventing them from growing and dividing rapidly. Unfortunately, a number of the body's normal, noncancerous cells (e.g., hair cells, red and white blood cells, blood-clotting platelets, cells that line the gastrointestinal tract) also divide rapidly, and are harmed by chemotherapy. Damage to these cells causes side effects, which depend upon the type and dose of the drugs, as well as the length of time that they are used. If the leukemia does not respond to one or two courses of treatment, a different drug program may be used to achieve remission. A different drug program may also be used if a relapse occurs. Chemotherapy side effects may include: temporary hair loss; mouth sores; anemia or a decreased number of red blood cells that may cause fatigue, dizziness, and shortness of breath; leukopenia or a decreased numbers of white blood cells that may lower resistance to infection; thrombocytopenia or a decreased number of platelets that may lead to easy bleeding or bruising; and gastrointestinal symptoms, including nausea, vomiting, and diarrhea. Radiation therapy: Radiation therapy is used along with chemotherapy for some kinds of leukemia. Radiation therapy (also called radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. Radiation therapy for leukemia may be given in two ways. For some individuals, the doctor may direct the radiation to one specific area of the body where there is a collection of leukemia cells, such as the spleen or testicles. Others may receive radiation that is directed to the whole body. This is called total-body irradiation. This type of radiation usually is given before a bone marrow transplant. Depending on how and where the radiation is administered, it may cause certain side effects such as fatigue (extreme tiredness), loss of appetite, nausea, diarrhea, and skin problems. Radiation of lymph node areas may result in suppression of the immune system to varying degrees. Irradiation of the underlying bone and the marrow within the bone may result in suppression of the blood counts. Interferon therapy: Interferons are a class of proteins that are released by virus-infected cells. They help normal cells to make antiviral proteins. Interferons also help the body to reduce leukemia cell growth and reproduction, while strengthening the body's immune response. Interferon-alpha (INFa) is a type of interferon that frequently is used to treat leukemia. Interferon-alpha can be given by a number of methods. Subcutanous injection is the customary route. INF-a is usually offered to all newly diagnosed patients who are not candidates for stem cell transplantation. Possible IFN-a-related complaints include fevers, chills, muscle aches, bone pain, headaches, concentration difficulties, fatigue, nausea, vomiting, and general flu-like symptoms when starting the drug. Such symptoms usually last for one to two weeks, but may be lessened by drugs such as acetaminophen (Tylenol®). Side effects recur if the INF-a dosage is increased, but they are temporary and usually improve after INF-a therapy is completed. Stem cell transplantation: Stem cell transplantation, or bone marrow transplant, is a treatment that allows use of very high doses of chemotherapy along with total body irradiation in order to kill the leukemic cells. At the completion of high-dose therapy, the individual's immune system is essentially depleted, and they are at high risk of developing serious life-threatening infections. These individuals are treated in specially designed, sterile, air-filtered marrow transplant rooms. Stem cell transplantation is a surgical procedure performed under general anesthesia. Immediately upon completion of the high-dose therapy, stem cells from a healthy, complete blood cell matched donor, usually a sibling or, less commonly, a parent, are transplanted into a vein whereupon they migrate to the marrow where they grow and multiply before entering the circulation. This process may take two to three weeks to be completed. On rare occasions, when a donor is not available, one's own marrow cells, usually pretreated in order to remove residual, but otherwise unseen, leukemic cells, are infused. This approach is far less successful than the use of matched donor cells. If an individual receives stem cells from a matched donor, the type of stem cell transplant is called allogeneic. If the individual's own stem cells are reintroduced back into the patient following high dose therapy, the infusion is called autologous. Side effects include fever and fatigue. Surgery: A splenectomy is the surgical removal of the spleen. The spleen is located in the abdomen, on the left side. The spleen acts as a filtering system for blood cells. When an individual has chronic leukemia, the spleen tends to collect leukemia cells, transfused platelets (given during surgery), and red blood cells. Frequently, the spleen enlarges from storing these cells. This makes it difficult for the chemotherapy to reduce the quantity of diseased cells. If the spleen is not removed, it sometimes grows so large that it causes breathing difficulty and compresses other organs. In that case, a splenectomy may be needed. Splenectomy is used along with other treatments, such as chemotherapy and radiation.
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