Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.
Treatment for leukaemia depends on:
- the stage of the disease
- the location of the cancer
- the severity of symptoms
- your general health and wishes.
Treatment may involve the following.
Surgery is not useful in treating leukaemia because the cancer cells are spread throughout the bone marrow and often in many other organs.
However, the spleen may need to be removed in CLL, CML or hairy cell leukaemia if it becomes so enlarged that it is pressing on nearby organs, or if it is removing too many blood cells from the bloodstream. The spleen is removed to relieve symptoms, rather than to cure the leukaemia.
Some people with leukaemia may receive chemotherapy.
Chemotherapy is the main treatment for people with ALL and AML. It may be given over the course of several years.
One potential side effect of chemotherapy that is more likely with leukaemia (and lymphoma) than with other types of cancer is tumour lysis syndrome. This occurs when the large number of leukaemia cells in the body break open after they are killed by the chemotherapy medications, releasing their contents into the bloodstream. This can overwhelm the kidneys, leading to a number of serious problems. Extra fluids and certain medicines may be given to avoid this syndrome.
Some people with leukaemia may receive radiotherapy.
Radiotherapy is not usually a major treatment for leukaemia. However, it may be used to treat leukaemia that has spread to the central nervous system or testicles, or to treat symptoms caused when swollen internal organs, such as the spleen, press on other organs. It may also be used before a stem cell transplant. Radiotherapy can be used to relieve pain in bones to which leukaemia has spread.
Targeted therapy [link] refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells. These types of medicines affect the way that cancer cells grow, divide, repair themselves or interact with other cells.
Medicines used for targeted therapy of ALL and CML include imatinib, dasatinib, nilotinib, bosutinib and ponatinib. These belong to a class of medicines called tyrosine kinase inhibitors and attack a protein (BCR-ABL) that is made by leukaemia cells in ALL and CML.
Blinatumomab is a type of monoclonal antibody that can be used to treat some types of ALL. It helps the immune system to attack the cancer cells.
Rituximab, obinutuzumab, ofatumumab and alemtuzumab are monoclonal antibody medicines that are used to treat CLL; rituximab may also be used for some types of ALL. They target a protein found on the surface of leukaemia cells. Ibrutinib and idelalisib are other targeted medicines (kinase inhibitors) that may be used to treat CLL.
Chemotherapy may be given in high doses to treat leukaemia, followed by a stem cell transplant to restore the bone marrow that has been destroyed by the chemotherapy treatment. The transplanted cells may come from a donor or from the patient’s own body. They may be taken from the blood, the bone marrow or umbilical cord blood.
A stem cell transplant from another person (a donor) is only possible if that person has a tissue type that closely matches that of the person with leukaemia. The best donor is often a close relative.
If large numbers of leukaemia cells in the bloodstream are causing problems with normal circulation, a procedure called leukapheresis may be used. This involves passing the blood through a machine that removes white blood cells and then returns the treated blood back into the bloodstream.
Immunotherapy involves treatment with medicines that boost the ability of the immune system to attack cancer cells. Interferon-alpha may be used as immunotherapy to treat CML, although tyrosine kinase inhibitors are now preferred.
Treatment for leukaemia often lasts for years. Some people may require ongoing chemotherapy or radiotherapy to keep the leukamia under control. CLL and CML are rarely cured, and treatment may continue at intervals for life.
After treatment for leukaemia, you will need regular follow-up examinations and tests to look for return of the cancer or side effects from treatment.
If leukaemia treatment is unsuccessful, palliative treatment to control the symptoms of the disease may be the best option. This might include radiotherapy and pain-relieving medicines to reduce pain from leukaemia in the bones, blood transfusions to treat fatigue, and use of food supplements and medicines to treat nausea and loss of appetite.
Leukaemia may recur (come back) after treatment. Secondary cancer is when the cancer spreads to another part of the body.
Treatment options for recurrent leukaemia include further chemotherapy, possibly using different medicines or higher doses, targeted treatment with blinatumomab (for some types of ALL) or a stem cell transplant.
- National Comprehensive Cancer Network (2014). NCCN guidelines for patients: acute lymphoblastic leukemia, version 2.2014 http://www.nccn.org/patients/guidelines/all/index.html.
- American Cancer Society. Acute lymphocytic leukemia (ALL) in adults http://www.cancer.org/cancer/leukemia-acutelymphocyticallinadults/index.
- National Cancer Institute (2015). Adult acute lymphoblastic leukemia treatment (PDQ®) http://www.cancer.gov/types/leukemia/patient/adult-all-treatment-pdq, patient version.
- American Cancer Society. Acute myeloid leukemia (AML) http://www.cancer.org/cancer/leukemia-acutemyeloidaml/index.
- American Cancer Society. Chronic lymphocytic leukemia (CLL) http://www.cancer.org/cancer/leukemia-chroniclymphocyticcll/index.
- American Cancer Society. Chronic myeloid leukemia (CML) http://www.cancer.org/cancer/leukemia-chronicmyeloidcml/index.
- National Cancer Institute (2015). Chronic myelogenous leukemia treatment (PDQ®) http://www.cancer.gov/types/leukemia/patient/cml-treatment-pdq, patient version.
- National Comprehensive Cancer Network (2014). NCCN guidelines for patients: chronic myelogenous leukemia, version 1.2014 http://www.nccn.org/patients/guidelines/cml/index.html.