Leukemia: Treatments

In the United States, over 48,000 cases of leukemia are diagnosed each year. Since this disease is relatively rare, patients should be treated at a major medical center by physicians with special expertise in this condition.

At the Herbert Irving Comprehensive Cancer Center we take a multidisciplinary team approach, providing the most innovative treatments and the highest level of patient care. Our internationally known surgeons, hematologists (those who study of blood diseases), oncologists, and radiation specialists, work together to design a treatment program tailored to every patient’s needs.

The acute leukemias, AML and ALL, are treated quickly. Our goal is to rid the body of leukemia cells and restore production of normal blood cells. Once a patient is in remission, additional treatment is usually needed to prevent the disease from coming back. In some cases, our physicians will recommend stem cell transplantation.

Chronic myeloid leukemia (CML) is usually treated with medications taken in pill form.

Chronic lymphocytic leukemia (CLL) may not need to be treated right away—only if symptoms develop in the future, or if this slow growing leukemia interferes with the production of normal blood cells.

Our approaches to leukemia include:

• Chemotherapy
• Radiation therapy
• Antibody therapy
• Targeted therapy
• Stem cell transplant (from the peripheral blood or bone marrow)

Chemotherapy

Chemotherapy uses drugs to destroy leukemia cells throughout your body. It can be delivered in three ways:

  • Orally (a pill taken by mouth)
  • Intravenously (though a vein)
  • Intrathecally (through the fluid the spinal cord or surrounding the brain)

Our oncologists will determine, through tests such a tumor molecular profiling, which drug or combination of drugs will best fight your disease, with the lowest possible toxicity and side-effects.
While chemotherapy can be our most effective means of treating leukemia, it can also produce nausea, vomiting, hair loss, fatigue and mouth sores. Our team will work with you to help manage and prevent these side-effects.
We will also monitor the effectiveness of your chemotherapy regimen, on an ongoing basis, with blood tests, physical exams and imaging scans.

Stem Cell and Bone Marrow Transplant

Certain leukemia patients may benefit from stem cell transplantation. Blood stem cell transplants allow us to replace diseased or damaged marrow with healthy cells.

Bone marrow transplants may be prescribed for patients with ALL, AML and rarely for patients with CLL and CML.

More information on bone marrow and stem cell transplants can be found here.

Antibody Therapy

Antibody therapy is sometimes referred to as passive immunotherapy because it doesn’t directly cause your immune system to respond to a disease. Instead it relies on a protein made in a laboratory that attaches itself to the surface of the cancer cell. This protein makes the cancer cell more visible to the immune system.

Antibodies (sometimes called monoclonal antibodies because they are “cloned” from a single cell in the lab), also block the growth signals sent to cancer cells.

The side-effects of antibody therapy are generally milder than chemotherapy. Because they target specific parts of a cancer cell, they leave normal cells unharmed. There are two of kinds of antibody treatments.
Naked antibodies identify specific cancer cells and induce an immune response.

Conjugated antibodies deliver radioactive isotopes or toxins directly to the cancer cells. The drugs include Daunorubicin (Cerubidine®), doxorubicin (Adriamycin®), idarubicin (Idamycin®) and mitoxantrone (Novantrone®).

Antibody therapies are usually given in an outpatient setting over several weeks. The drug is delivered through a needle placed in the patient’s vein. Physicians often prescribe drugs before each infusion to reduce common side effects.

Targeted Therapy

In recent years, new drugs have been developed to target genes, proteins and the tissue environment that encourages cancer cells to grow. Since these drugs work differently than standard chemotherapy (chemo) they may have fewer side effects.

These drugs are sometimes given by themselves or in addition to other therapies such as chemotherapy and/or antibody therapy. By combining targeted therapy with other approaches we can increase the chance of the cancer responding to treatment and decrease the risk of it coming back.

Treatment for Acute Lymphoblastic Leukemia (ALL)

Treatment for ALL is based upon several factors.

• The subtype of ALL
• The number of leukemia cells found in the blood
• Whether there are any abnormal chromosomes
• Whether this condition has been treated before and how
• The patient’s age and general health

Treatments may include

• Chemotherapy
• Drugs targeting the Philadelphia chromosome if present
• Immunotherapy including monoclonal antibodies
• Radiation
• Bone marrow transplantation
• Investigational approaches looking at new therapies and therapy combinations

Treatment for Acute Myeloid Leukemia (AML)

Treatment for AML is based upon several factors.

• The AML subtype
• Whether there are any abnormal chromosomes or gene mutations.
• Whether this condition has been treated before and how
• The patient’s age and general health

Treatments may include

• All-trans-retinoic acid (ATRA) and Arsenic trioxide in combination with chemotherapy for patients with acute promyelocytic leukemia (APL)
• Chemotherapy
• Immunotherapy including monoclonal antibodies
• Targeted therapy
• Bone marrow transplantation
• Investigational approaches looking at new therapies and therapy combinations

Treatment for Chronic Lymphocytic Leukemia (CLL)

Treatment for CLL usually begins only once the patient has developed significant symptoms or decline in blood counts and is based upon

• The stage of the disease
• Whether there are any abnormal chromosomes or gene mutations
• The patient’s age and overall health

Patients with intermediate and high-risk CLL may be treated with

• Supportive care including transfusions of blood products
• Chemotherapy
• Immunotherapy including monoclonal antibodies
• Targeted therapy
• Bone marrow transplantation
• Investigational approaches looking at new therapies and therapy combinations

Treatment for Chronic Myeloid Leukemia (CML)

Treatment for CML is based upon several factors:

• The phase of the disease (chronic, accelerated, blastic)
• Whether there are any additional abnormal chromosomes
• Whether the disease has been previously treated and how
• The patient’s general health

For Chronic Phase CML

• There are currently five drugs approved for the treatment of CML that block the BCR-ABL protein which is a tyrosine kinase. These tyrosine kinase inhibitors (TKI) include imatinib (Gleevec), nilotinib (Tasigna), dasatinib (Sprycel), bosutinib (Bosulif) and ponatinib (Iclusig). Which drug is chosen depends on multiple factors including prior treatment and the individual side effects of each drug.

• Stem cell transplantation

For Accelerated Phase CML

• All the options above plus
• Chemotherapy
• Bone marrow transplantation
• Investigational approaches looking at new therapies and therapy combinations

For Blastic Phase CML

• Chemotherapy
• Stem cell transplantation
• Investigational approaches looking at new therapies and therapy combinations