Leukemia Treatments - Specialists and Information on Blood Cancer

Leukemia treatment is used when doctors diagnose blood cancer. They tailor the treatment to each individual patient and the specific type of leukemia.

Leukemia treatments can vary widely. They may take place in different settings (outpatient or inpatient). They differ significantly from one another in terms of the medications used, surgical procedures, and other methods.

Furthermore, the combination of individual treatment approaches depends on the stage of the disease.

All forms of leukemia require treatment, as they can lead to death relatively quickly. In all forms of leukemia, there is uncontrolled growth of immature blood cells. However, different stages of blood cell development and different types of blood cells may be affected. This is why there are different forms of leukemia.

Figuratively speaking, the disease is like a flood of uncontrolled, immature blood cells in the bloodstream. Over time, these leukemic blasts displace the healthy, fully mature blood cells in the bone marrow. This is problematic because new, healthy blood cells can no longer enter the bloodstream to replace the old cells.

The immature blasts, so to speak, displace the healthy blood cells. As a result, there are more and more blood cells in the bloodstream that serve no useful purpose.

As a result, symptoms develop that affect nearly the entire body. The blasts travel through the blood to various organs in the body and accumulate there. This, in turn, leads to localized symptoms.

In leukemia, there is a significantly elevated number of white blood cells in the blood @ elenabsl /AdobeStock

Doctors distinguish between two main types of leukemia: acute and chronic leukemia.

• Acute leukemia

Acute forms occur suddenly and are characterized by a severe and rapid course of the disease. If left untreated, they lead to death within a few weeks.

• Chronic leukemia

Chronic forms of leukemia develop gradually and often go unnoticed for longer periods.

Experts also classify leukemia based on the types of cells affected:

• Lymphocytic Leukemia
• Lymphocytic leukemias originate from precursor cells of lymphocytes.
• Myeloid Leukemia
• Myeloid leukemias originate from the precursors of erythrocytes, thrombocytes, granulocytes, and monocytes.

The necessary treatments vary significantly depending on the type and stage of leukemia. For acute forms of leukemia, the following therapies are primarily used:

• Chemotherapy
• Radiation therapy
• Stem cell transplant

As part of chemotherapy, which is usually the cornerstone of treatment, doctors administer cytostatic drugs. These drugs inhibit cell growth, thereby preventing immature blood cells from continuing to multiply uncontrollably.

Doctors administer chemotherapy in several cycles. They take breaks between chemotherapy sessions to give healthy cells time to recover, since they are also affected by the cytostatic drugs.

Not all leukemic blasts can be eliminated by chemotherapy. In particular, those that have already reached the brain do not respond to treatment.

For this reason, doctors also administer radiation to the skull. In some cases, they also treat the chest area. The radiation kills the blasts.

Another approach involves replacing the diseased bone marrow with healthy bone marrow. This is done as part of a stem cell transplant. In this procedure, doctors administer purified blood stem cells from a donor to the patient.

In chronic myeloid leukemia, in addition to chemotherapy and stem cell transplantation, two specific medications are used:

• interferon α and
• tyrosine kinase inhibitors

Interferon α has an immunomodulatory effect and ensures that the immune system begins to fight the leukemia cells on its own. Tyrosine kinase inhibitors, on the other hand, inhibit the continuous division of the diseased cells.

The treatment for chronic lymphocytic leukemia differs yet again from the approaches described so far. In this case, doctors typically adopt a wait-and-see approach and monitor the patient closely: Many patients remain symptom-free for years; treatment is not advisable at this stage.

If the condition worsens, doctors also use chemotherapy and stem cell transplantation in this case. In addition, antibodies that specifically target the leukemia cells are used to treat chronic lymphocytic leukemia.

Follow-up care is of great importance in leukemia treatment. The main goal is to help patients return to their daily lives and to detect relapses early. Regular follow-up examinations are therefore strongly recommended.

In addition:

• rehabilitation
• psychotherapy, as well as
• treatment of comorbidities

Leukemia treatment is not without side effects:

• Chemotherapy places an enormous strain on the body, as it slows the growth of not only diseased cells but also healthy ones. In addition to acute side effects, this can also lead to long-term consequences such as infertility. 
• Radiation therapy can also have long-term effects. 
• Targeted therapies using antibodies, tyrosine kinase inhibitors, or interferon α cause fewer side effects but are not suitable for all forms of leukemia.
• Stem cell transplantation is also associated with risks and side effects. In addition to the general risks of surgery, there is a small risk that the body will not accept the new stem cells. Furthermore, patients must continue taking medication for an extended period after the transplant to prevent rejection.

The prognosis after treatment depends heavily on the type and stage of the disease, as well as the patient’s age:

• Acute lymphoblastic leukemia can be cured in 40 to 50 percent of adults and in about 80 percent of children.
• In acute myeloid leukemia, only about 30 percent of those affected are still alive five years after diagnosis. It can be cured in only 20 percent of cases. 
• For chronic lymphocytic leukemia, the average life expectancy from the time of diagnosis in the early stages is over ten years.
• Chronic myeloid leukemia can usually be completely cured through stem cell transplantation.