Leukemia (cont.)
How is leukemia treated?
Many people with leukemia want to
take an active part in making decisions about their medical care. They want to
learn all they can about their disease and their treatment choices. However, the
shock and stress after a
diagnosis of cancer can make it hard to think of everything to ask the
doctor. Often it helps to make a list of questions before an appointment. To
help remember what the doctor says, patients may take notes or ask whether
they may use a tape recorder. Some also want to have a family member or
friend with them when they talk to the doctor—to take part in the
discussion, to take notes, or just to listen.
The doctor may refer patients to doctors who specialize
in treating leukemia, or patients may ask for a referral. Specialists who treat
leukemia include hematologists, medical oncologists, and radiation oncologists.
Pediatric oncologists and hematologists treat childhood leukemia.
Whenever possible, patients should be treated at a medical center that has
doctors experienced in treating leukemia. If this is not possible, the patient's
doctor may discuss the treatment plan with a specialist at such a center.
Getting a second opinion
Sometimes it is helpful to have a second opinion about the diagnosis and the
treatment plan. Some insurance companies require a second opinion; others may
cover a second opinion if the patient or doctor requests it. There are a number
of ways to find a doctor for a second opinion:
- The patient's doctor may be able to suggest a doctor who specializes in
adult or childhood leukemia. At cancer centers, several specialists often
work together as a team.
- The Cancer Information Service, at 1-800-4-CANCER, can tell callers
about nearby treatment centers.
A local or state medical society, a nearby hospital,
or a medical school
can usually provide the names of specialists.
- The American Board of Medical Specialties (ABMS) has a list of doctors
who have met certain education and training requirements and have passed
specialty examinations. The Official ABMS Directory of Board Certified
Medical Specialists lists doctors' names along with their specialty and
their educational background. The directory is available in most public
libraries. Also, ABMS offers this information on the Internet at http://www.abms.org.
(Click on "Who's Certified.")
Preparing for treatment
The doctor can describe treatment choices and discuss the results expected
with each treatment option. The doctor and patient can work together to develop
a treatment plan that fits the patient's needs.
Treatment depends on a number of factors, including the
type of leukemia, the patient's age, whether leukemia cells are present in the
cerebrospinal fluid, and whether the leukemia has been treated before. It also
may depend on certain features of the leukemia cells. The doctor also takes into
consideration the patient's symptoms and general health.
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These are some questions a person may want to ask the doctor before
treatment begins:
- What type of leukemia do I have?
- What are my treatment choices? Which do you
recommend for me? Why?
- What are the benefits of each kind of
treatment?
- What are the risks and possible side effects of
each treatment?
- If I have pain, how will you help me?
- What is the treatment likely to cost?
- How will treatment affect my normal activities?
- Would a clinical trial (research study) be appropriate for me?
Can you help me find one?
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People do not need to ask all of their questions or understand all of the
answers at one time. They will have other chances to ask the doctor to explain
things that are not clear and to ask for more information.
Methods of treatment
The doctor is the best person to describe the treatment choices and
discuss the expected results. Depending on the type and extent of the disease,
patients may have chemotherapy, biological therapy, radiation therapy, or
bone marrow transplantation. If the patient's spleen is enlarged, the doctor may
suggest surgery to remove it. Some patients receive a combination of treatments.
People with acute leukemia need to be treated right
away. The goal of treatment is to bring about a remission. Then, when signs and
symptoms disappear, more therapy may be given to prevent a relapse. This type of therapy
is called maintenance therapy. Many people with acute leukemia can be cured.
Chronic leukemia patients who do not have symptoms may not require immediate
treatment. The doctor may suggest watchful waiting for some patients with
chronic lymphocytic leukemia. The health care team will monitor the patient's
health so that treatment can begin if symptoms occur or worsen. When treatment
for chronic leukemia is needed, it can often control the disease and its
symptoms. However, chronic leukemia can seldom be cured. Patients may receive
maintenance therapy to help keep the cancer in remission.
A patient may want to talk to the doctor about taking
part in a clinical trial, a research study of new treatment methods. The section
on "The Promise of
Cancer Research" has more information about clinical trials.
In addition to anticancer therapy, people with leukemia
may have treatment to control pain and other symptoms of the cancer, to relieve
the side effects of therapy, or to ease emotional problems. This kind of
treatment is called symptom
management, supportive care, or palliative care.
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.)
The patient may receive the drugs in two ways:
- Injection into the spine:
The doctor injects the drugs into the lower part of the spinal column.
- Ommaya reservoir: Children and some adult patients receive
intrathecal chemotherapy through a special catheter called an Ommaya
reservoir. The doctor places the catheter under the scalp. The doctor
injects the anticancer drugs into the catheter. This method avoids the
discomfort of injections into the spine.
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.
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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?
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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.
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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?
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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.
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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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Next: What are the side effects of treatment for leukemia? »
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