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Chemotherapy for Leukemia

Acute Lymphocytic Leukemia (ALL): Chemotherapy 

What is chemotherapy?

Chemotherapy uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

When might chemotherapy be used for ALL?

Chemotherapy is the main treatment for nearly all people with acute lymphocytic leukemia (ALL). If the first treatment with chemotherapy doesn't work, your doctor may advise another type of chemotherapy. This might be given in high doses along with a stem cell transplant. This depends on a variety of factors, such as your age and if the first treatment worked at all.

How is chemotherapy given for ALL?

If you get chemotherapy, you will meet with a hematologist/oncologist before treatment starts. This kind of doctor specializes in treating blood cancers like chemotherapy. The doctor will talk with you about your treatment and what you might expect. 

Chemotherapy for ALL is often given in phases. This gives the medicines a better chance of working well. The treatment phases of ALL include:

  • Remission induction. The goal of this phase is to quickly kill as many leukemia cells in the blood and bone marrow as possible. This usually puts the leukemia into remission. Remission means you don't have signs or symptoms of the cancer.

  • Consolidation (intensification) therapy. The goal of this phase is to kill any remaining leukemia cells and keep you in remission.

  • Maintenance therapy. The goal of this phase is to keep the leukemia in remission over a long period of time.                                                                                                                                                                         

Chemotherapy in the first two phases can be intense. You may need to spend some time in the hospital. Younger patients often get stronger chemotherapy. Older patients may get slightly less strong treatment.

What is intrathecal chemotherapy?

Intrathecalchemotherapy is a type of treatment that some people with ALL are given. The treatment sends medicine directly into the cerebrospinal fluid (CSF). This is the fluid that surrounds your brain and spinal cord. The medicine is given through a lumbar puncture. This is an injection in the lower part of your spine. A lumbar puncture can cause discomfort. This treatment is often used to treat ALL to kill or prevent the spread of cancer in your spine or brain. This is often started during the induction phase of chemotherapy. It may continue throughout your treatment.  You will likely get a combination of medicines. These are called methotrexate and cytarabine.

If you need long-term treatment for your brain, a surgeon can insert a small, soft plastic dome just under the scalp with minor surgery. The plastic dome is called an Ommaya reservoir. It lets your health care providers easily send medicine into your CSF. It can also be used to take a sample of CSF. This can let your healthcare providers see if the treatment is working. It can also check for signs of infection. When you no longer need the reservoir, the surgeon will remove it.

Treatment in the remission induction phase

This first phase of treatment lasts a month or so. You will likely get a combination of at least 3 chemotherapy medicines. This makes it more likely that the treatment will work. Which medicines you get and how long you receive them depends on many factors. They include your age and overall health, the subtype of ALL, and how well the leukemia responds to treatment.

The medicines most often used in this phase include: 

  • Vincristine

  • Dexamethasone or prednisone

  • Doxorubicin or daunorubicin

  • Cyclophosphamide

  • L-asparaginase or pegaspargase

  • Cytarabine

  • Methotrexate

  • Etoposide

You may also get blood transfusions during this time if your blood cell counts get too low. Your healthcare team will check you closely for side effects. Side effects are more likely if you get high doses of medicine.

People whose leukemia cells have the Philadelphia chromosome will likely also get a targeted therapy medicine with chemotherapy. An example of this kind of medicine is imatinib. Targeted therapy medicine is taken daily as pills.

A few weeks after treatment, you will have a bone marrow biopsy and aspiration. This is done to look for any leukemia cells that remain. If there are still leukemia cells in your bone marrow, you may have a second course of chemotherapy. This is done to try to put the leukemia into remission.

Treatment in the consolidation (intensification) phase

Once your leukemia is in remission, the next phase of treatment is consolidation. This is an intense course of chemotherapy. It’s done to try to kill any remaining cancer cells. This phase includes many of the same medicines used in the induction phase. But they are given at higher doses. This phase usually lasts for a few months. Some people may have a stem cell transplant during this phase of treatment. Intrathecal chemotherapy may be continued during this phase. For people whose leukemia cells contain the Philadelphia chromosome, targeted therapy will continue through this phase.

Treatment in the maintenance phase

The maintenance phase may last 2 to 3 years. This phase is necessary for most types of ALL. It’s done because there still may be traces of leukemia cells in your body. The most common medicines for this phase of treatment are methotrexate and mercaptopurine. For people whose leukemia cells contain the Philadelphia chromosome, targeted therapy will continue through this phase. 

What are common side effects of chemotherapy?

Chemotherapy medicines are designed to attack and kill cells that divide quickly, including cancer cells. These medicines can also affect normal cells that grow quickly. These include hair, and bone marrow cells where new blood cells are made. The side effects of chemotherapy are different for everyone. They usually go away when the treatment ends.

Chemotherapy for ALL is typically given in high doses. This can often lead to serious side effects. These usually go away when the treatment ends. The side effects can be different for each person. The most common short-term side effects of chemotherapy for ALL include:

  • Nausea and vomiting

  • Loss of appetite 

  • Easy bruising or bleeding, from low levels of blood platelets

  • Tiredness, from having low levels of red blood cells

  • Infections, from low levels of white blood cells

  • Hair loss

  • Headaches

  • Loss of sexual desire

  • Mouth sores

  • Pain when swallowing

  • Diarrhea

  • Pain, numbness, or tingling in the hands or feet

Some side effects may not go away after treatment. For example, some medicines may damage the heart or other organs, or may affect your fertility. Doctors try to limit this damage by watching the doses of chemotherapy carefully. Some medicines may raise your risk of growing other types of cancer later on. These risks need to be weighed against the benefits these medicines provide in treating your ALL.

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, ask your healthcare team how they work, and what side effects they might have.

Talk with your healthcare providers about what signs to look for, and when to call them. Make sure you know what number to call with questions, even on evenings and weekends.

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your medical team to make a plan to manage your side effects.

Chronic Lymphocytic Leukemia (CLL): Treatment Choices 

There are various treatment choices for chronic lymphocytic leukemia (CLL). Which one may work best for you? It depends on a number of factors. These include the stage of your CLL and the results of certain tests you have. Factors also include if the CLL is causing symptoms, as well as your age, overall health, and what side effects you’ll find acceptable.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision for you.

Types of treatment for CLL

Different types of treatment have different goals. Here are some of the types of treatment and their goals for people with CLL. 

  • Watchful waiting. This is also called observation. It’s a period when your doctor watches your leukemia closely before treating you. He or she waits until you have symptoms or the disease is clearly progressing. Studies have shown that people with limited disease who aren't having any symptoms don't benefit from early treatment. But they might still be bothered by the side effects of the disease. During this time, your doctor can treat any problems caused by the leukemia, such as infection.

  • Chemotherapy. This is usually the main way to treat CLL. Its goal is to stop the growth of cancer cells and prevent them from growing again. You may be treated with just one medicine. Or you may receive at least 2 medicines at a time. This is called combination chemotherapy. You have medicines by injection or in pill form. The medicines are often given in cycles. Chemotherapy may also be combined with targeted therapy. Or it may be done along with a stem cell transplant. This is used to help replace cells lost during high-dose treatment. The type and stage of CLL will help determine the way chemotherapy is given.

  • Targeted therapy. These are medicines that target a specific part of leukemia cells. One example used in CLL is monoclonal antibodies. These are synthetic versions of immune system proteins. The proteins are used to try to kill leukemia cells or slow their growth. Monoclonal antibody therapy is given by IV. Some other types of targeted therapy are taken as pills.

  • Leukapheresis. This treatment is done by passing blood from an IV through a machine that removes white blood cells, including leukemia cells. The filtered blood, including the remaining cells and plasma, are then returned back to you through another IV. Large numbers of leukemia cells can sometimes cause problems with normal circulation in people with CLL. Chemotherapy is the main treatment to lower the number of these cells, but it can take a few days to lower the cell count. Although the effect of leukapheresis is temporary, it may be advised while waiting for the chemotherapy to work.

  • Stem cell transplant with high-dose chemotherapy. If the normal doses of chemotherapy don't work, your doctor may need to give you very high doses of chemotherapy. These high doses can damage the stem cells in your bone marrow. Blood stem cells are the "starter" cells for new blood cells. In some cases before chemotherapy, the doctor removes some stem cells from a volunteer donor and freezes them. They are then given to you after treatment to restore your body's lost blood cells. This is called a stem cell transplant.

  • Radiation therapy. This type of therapy uses high-energy X-rays to kill cancer cells or prevent their growth. It's not often part of the standard treatment for CLL, but your doctor may advise it in certain cases. Radiation may be used right before a stem cell transplant. In rare cases, it may be used to shrink a tumor or an enlarged organ, such as the spleen. A doctor may advise radiation therapy to treat pain from bone damage that leukemia cells can cause.

  • Surgery. A splenectomy is a surgery to remove your spleen. In rare cases, this may be advised in the treatment of CLL. It doesn’t cure the leukemia, but it can improve symptoms. This may be done to improve blood cell counts or to reduce pressure on other organs caused by a swollen spleen.

Clinical trials for new treatments

Researchers are always finding new ways to treat CLL. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare providers

At first, thinking about treatment options may seem overwhelming. Talk with your doctors, nurses, and loved ones. Make a list of questions. Consider the benefits and possible side effects of each option. Discuss your concerns with your healthcare providers before making a decision.

 

Acute Myeloid Leukemia (AML): Chemotherapy 

What is chemotherapy?

Chemotherapy uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

When might chemotherapy be used for AML?

Chemotherapy is the main treatment for nearly all people with acute lymphocytic leukemia (AML). It isn’t used for some people with a subtype of AML known as acute promyelocytic leukemia (APL). 

If the first treatment with chemotherapy doesn't work, your doctor may advise another type of chemotherapy. This might be given in high doses along with a stem cell transplant. This depends on a variety of factors, such as your age and if the first treatment worked at all.

How is chemotherapy given for AML?

If you get chemotherapy, you will likely meet with a hematologist/oncologist before treatment starts. This doctor specializes in treating blood cancers like leukemia with chemotherapy. The doctor will talk with you about your treatment and what you might expect.

Chemotherapy for AML is often given in phases. This gives the medicines a better chance of working well. The treatment phases of AML include:

  • Remission induction. The goal of this phase is to quickly kill as many leukemia cells in the blood and bone marrow as possible. This usually puts the leukemia into remission. Remission means you don't have signs or symptoms of the cancer.

  • Consolidation (intensification) therapy. The goal of this phase is to kill any remaining leukemia cells and keep you in remission.

Chemotherapy in the first two phases can be intense. You may need to spend some time in the hospital. Younger patients often get stronger chemotherapy. Older patients may get slightly less strong treatment.

Treatment in the remission induction phase

During this first phase of treatment, you will likely need to stay in the hospital. You may be kept in isolation. This is to help protect you from other people's germs. You get chemotherapy through a vein (IV). You usually get a combination of 2 medicines. This makes it more likely that the treatment will work well. Which medicines you get and how long you receive them depends on factors such as your age and overall health.

You’ll likely receive the medicine cytarabine for 7 days. Your doctor will likely combine this with 3 days of an anthracycline medicine such as  daunorubicin or  idarubicin. This 7-day plus 3-day protocol puts the leukemia cells in contact with medicines at different phases of their growth. This makes it more likely that the cells will be killed. Your doctor may also add another medicine.

You may also get blood product transfusions during this time if your blood cell counts get too low. Your healthcare team will check you closely for side effects. Side effects are more likely if you get high doses of medicines.

A few weeks after treatment, you will have a bone marrow biopsy and aspiration. This is done to look for any leukemia cells that remain. If there are still leukemia cells in your bone marrow, you may have a second course of chemotherapy. This is done to try to put the leukemia into remission.

Treatment in the consolidation (intensification) phase

Once your leukemia is in remission, the next phase of treatment is consolidation. This is an intense course of chemotherapy. It’s done to try to kill any remaining cancer cells. The goal of this phase of treatment is to keep you in remission or to prevent relapse. You may get higher doses of chemotherapy medicines for several days. This will be repeated once a month for a few months. Another option may be very high-dose chemotherapy along with a stem cell transplant. Younger people usually have stronger chemotherapy. Older adults may have less-strong treatment.

What are common side effects of chemotherapy?

Chemotherapy medicines are designed to attack and kill cells that divide quickly, including cancer cells. These medicines can also affect normal cells that grow quickly. These include hair, and bone marrow cells where new blood cells are made. The side effects of chemotherapy are different for everyone. They usually go away when the treatment ends.

Chemotherapy for AML is typically given in high doses. This can often lead to serious side effects. These usually go away when the treatment ends. The side effects can be different for each person. The most common short-term side effects of chemotherapy for AML include:

  • Hair loss

  • Infections, from low levels of white blood cells

  • Easy bruising or bleeding, from low levels of blood platelets

  • Tiredness, from having low levels of red blood cells

  • Mouth sores

  • Loss of appetite

  • Nausea and vomiting

  • Inflammation of the membrane covering the eye and lining the eyelid (conjunctivitis)

A possible long-term severe side effect of chemotherapy is organ damage. The risk depends on the medicines used. It can include damage to the kidneys, liver, testicles, ovaries, brain, heart, or lungs. Doctors and nurses watch treatment closely to try to reduce the risk of these side effects.                                                                                                                                                                   

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, ask your healthcare team how they work, and what side effects they might have.

Talk with your healthcare providers about what signs to look for, and when to call them. Make sure you know what number to call with questions, even on evenings and weekends.

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your medical team to make a plan to manage your side effects.

Chronic Lymphocytic Leukemia (CLL): Chemotherapy

What is chemotherapy?

Chemotherapy uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

When might chemotherapy be used for CLL?

For chronic lymphocytic leukemia(CLL), chemotherapy is usually the first treatment after watchful waiting. Your doctor may advise chemo if you start to have symptoms or have signs that the leukemia is getting worse. Chemotherapy is not likely to cure CLL. But it can often help keep it under control. Even if the leukemia is very advanced, chemotherapy may help ease symptoms. This can improve your quality of life.

How is chemotherapy given for CLL?

Most people have chemotherapy in an outpatient part of the hospital, at a doctor's office, or at home. In some cases, you may need to stay in the hospital during treatment. This will depend on the medicines you are given and your overall health. You may take these medicines in pill form, by injection, or IV. You may take the medicines in more than one of these ways.                                                                                 

You get chemotherapy in cycles over a period of time. That means you may take the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is one cycle. You may have several cycles. Having treatment in cycles helps by: 

  • Killing more cancer cells. The medicine can kill more cancer cells over time, because the cells aren't all dividing at the same time. Cycles allow the medicine to fight more cells.

  • Giving your body a rest. Treatment is hard on other cells of the body that divide quickly. This includes cells in the lining of the mouth and stomach. This causes side effects, such as sores and nausea. Between cycles, your body can get a rest from the chemotherapy.

  • Giving your mind a rest. Having chemotherapy can be stressful. Taking breaks between cycles can let you get an emotional break between treatments.

What are the medicines used to treat CLL?

The medicines used most often for CLL include:

  • Fludarabine

  • Cladribine

  • Pentostatin

  • Chlorambucil

  • Cyclophosphamide

  • Doxorubicin

  • Vincristine

  • Bendamustine

You may have one medicine at a time, or a combination of medicines. In some cases chemotherapy medicines are combined with other medicines called targeted therapy. 

The medicines you get and how often you take them will depend on many factors. These factors include your overall health and the stage and type of your leukemia. The factors also include your age. For example:

  • If you're younger, your doctor may try fludarabine. You may take it as a single medicine. Or you may take it with rituximab or other medicines.

  • If you are older or have health problems, your doctor may give you a medicine that is likely to have fewer side effects. You may be given chlorambucil.

Your doctor may also give you steroids such as prednisone during your treatment. Prednisone helps fight a problem of CLL in which the immune system attacks the body’s own red blood cells or platelets.

What are common side effects of chemotherapy?

Chemotherapy medicines are designed to attack and kill cells that divide quickly, including cancer cells. These medicines can also affect quickly dividing normal cells. These include hair, and bone marrow cells where new blood cells are made. The side effects of chemotherapy are different for everyone. They usually go away when the treatment ends.

The most common short-term side effects of chemotherapy include:                                                                                                                                            

  • Loss of appetite

  • Easy bruising or bleeding, from low levels of blood platelets

  • Diarrhea

  • Tiredness, from having low levels of red blood cells

  • Hair loss

  • Headaches

  • Increased chance of infections, from low levels of white blood cells

  • Loss of sexual desire

  • Mouth sores

  • Nausea and vomiting 

  • Pain when swallowing 

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, ask your healthcare team how they work, and what side effects they might have.

Talk with your healthcare providers about what signs to look for, and when to call them. Make sure you know what number to call with questions, even on evenings and weekends.

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your medical team to make a plan to manage your side effects.