The most effective treatment for leukemia is chemotherapy, which may involve one or a combination of anticancer drugs that destroy cancer cells. Specific types of leukemia are sometimes treated with radiation therapy or biological therapy.
Each type of leukemia is sensitive to different combinations of chemotherapy. Medications and length of treatment vary from person to person. Treatment time is usually from one to two years.
Your treatment may consist of different chemotherapy drugs and biological therapies. The short-term goal is for a complete remission (CR). A complete remission means that the bone marrow has less than 5 % blasts, the absolute neutrophil counts is over 1,000 and the platelet count is over 100,000. The long-term goal is for an extended disease-free state and cure.
A course or cycle is the period of time from the start of your chemotherapy until either the blood and bone marrow cell counts are back to normal or when you are able to receive further treatment. In some cases, the leukemia cells are destroyed only from the blood and not from the bone marrow during the first course of chemotherapy. In these cases, a second course may be needed.
If the leukemia does not respond to one or two courses of treatment, a different drug program may be used to bring on a remission. A different drug program may also be used if a relapse occurs.
A specific treatment plan is called a protocol. Each protocol is usually named by letters with each letter standing for a particular drug. A protocol may be considered either standard or experimental therapy. Your doctor will discuss with you the advantages and disadvantages of a particular type of therapy.
Once your protocol is determined, you will receive more specific information about the drug(s) that will be used to treat your leukemia. Common side effects of most chemotherapy drugs include hair loss, nausea and vomiting, decreased blood counts and infections.
Radiation therapy is used along with chemotherapy for some kinds of leukemia. Radiation therapy (also called radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. The radiation comes from a large machine.
Radiation therapy for leukemia patients may be given in two ways. For some patients, the doctor may direct the radiation to one specific area of the body where there is a collection of leukemia cells, such as the spleen or testicles. Other patients may receive radiation that is directed to the whole body. This is called total-body irradiation. This type of radiation usually is given before a stem cell transplant.
Biological therapy is sometimes used to treat leukemia. Biological therapies include growth factors, interleukins, monoclonal antibodies, etc. Some patients receive only biological therapy, while others also receive chemotherapy at the same time. You will receive more detailed information about biological therapy if it is used as a treatment for your type of leukemia.
A splenectomy is the surgical removal of the spleen. The spleen is located in the abdomen, on the left side. It acts as a filtration system for blood cells. When a patient has chronic leukemia, the spleen tends to collect leukemia cells, transfused platelets and RBCs. Frequently the spleen enlarges from storing these cells. This makes it difficult for the chemotherapy to reduce the quantity of diseased cells. If the spleen is not removed, it sometimes grows so large that it causes breathing difficulty and compresses other organs. In that case, a splenectomy may be needed.
Stem Cell Transplantation
Stem cell transplantation (SCT) is a form of treatment for leukemia patients. This type of treatment was previously referred to as a “bone marrow transplant.” This treatment consists of destroying leukemic bone marrow cells using high doses of chemotherapy and in some cases, radiation therapy. Because high-dose chemotherapy severely damages the bone marrow’s ability to produce cells, healthy stem cells are provided intravenously to stimulate new bone marrow growth.
There are two types of stem cell transplantation:
- Autologous SCT involves infusion of your own healthy bone marrow cells. Your doctor may plan to store some of your bone marrow while you are in remission for an autologous transplantation.
- Allogeneic SCT involves the infusion of compatible donor cells to you. These cells can be obtained from the bone marrow of a donor or stem cells. Adult stem cells or umbilical cord stem cells can be used for transplantation.
Like other leukemia treatments, SCT is highly individualized. Different factors will help your doctor decide what specific treatment to use, including the type of leukemia you have, your past response to chemotherapytreatment, the availability of stem cells for replacement, your age and the status of your leukemia.
Treatment Side Effects
The medical team carefully reviews each person’s medical history and your physician will then recommend the best chemotherapy treatment. Responses and side effects to chemotherapy may differ from person to person or from one course to the next. The seriousness of side effects is not a measure of how the leukemia is responding to the chemotherapy. Only diagnostic tests such as blood counts and bone marrow tests will give this information.
Diagnostic tests are done at different times depending on the type of leukemia you have and the type of chemotherapy drug used. For example, a complete blood count (CBC) will often be done every 24 hours for acute leukemia, but will be done only once per week or less often for chronic leukemia. A bone marrow test will be done prior to the start of chemotherapy and again in two to three weeks in acute leukemia. Depending upon the results of the bone marrow test and blood cell counts, your doctor will order further bone marrow tests. In response to the chemotherapy, the bone marrow is emptied of both normal and abnormal cells. During the time the bone marrow is “empty,” no cells are produced. Both blood and bone marrow cell counts are usually back to normal between 21 and 31 days after the first day of chemotherapy, depending on the type of chemotherapygiven and the person’s response to the treatment.
In general, your white blood cell (WBC) count will fall within the first week after you start chemotherapy. As a result, you will be more prone to infection. Blood, urine, sputum, stool and throat cultures are collected to find out if an infection exists. These cultures may identify the specific organism, also known as bacteria, causing the infection. A chest x-ray will be taken because many infections occur in the lungs. If you are likely to get a specific type of infection when you are not sick such as a sinus infection, urinary tract infection or pneumonia, you have an increased chance of getting this infection each time your WBC count drops. Because of this, good personal hygiene is very important. Handwashing is the most important precaution for preventing infection. If you are unable to wash your hands after shaking hands, use a hand sanitizer.
The nursing staff will help you maintain good personal hygiene if you cannot manage it yourself (i.e., daily bathing and good mouth care). Please ask your visitors who may be sick, or think they are sick, not to visit with you while they are ill. Even wearing a mask will not completely prevent the spread of infection. Infections are treated with antibiotics given intravenously or by mouth for at least seven days. Your doctor will tell you about the antibiotic treatment in detail.
Your red blood cell count (RBC) will also decrease. This decrease can be seen by a drop in either your hematocrit or hemoglobin levels. Both will cause fatigue. You will be given a RBC transfusion as needed. As a general rule, red blood cells are transfused when your hemoglobin is at least 8.0 or lower. It is important to drink at least six to eight (8 oz.) glasses of fluids each day to flush the chemotherapy from your system. This should begin the day you start your chemotherapy and continue for four days after you have finished your treatment. If you are on IV fluids or fluid restrictions, check with your doctor or nurse before drinking this amount. As your RBC count drops, your heart may beat fast or you may feel lightheaded when you get up quickly. Report these side effects to your nurse or physician.
Another side effect of chemotherapy is a decrease in the number of platelets. If this happens, nosebleeds, bleeding gums or passing blood in the urine or stool are likely to happen. Little red dots may appear on parts of your body, especially the arms and legs. These dots are called petechiae, which means that there is bleeding from the capillaries, or small blood vessels in the skin. Platelet transfusions are usually, but not always, given when the platelet count is less than 10,000 or any time that bleeding occurs. Platelets are transfused only as needed because unnecessary transfusions may eventually cause your body to stop responding to platelet transfusions.
You must take special care of yourself when your platelet count is low. Use a very soft toothbrush to avoid irritating your gums and use an electric shaver rather than a blade for shaving. Dental flossing can be continued if you had practiced this previously but do not go down to the gum line. If you do injure or cut yourself, you can stop the bleeding by putting direct pressure to the wound for five to ten minutes. If you have vaginal bleeding, your doctor may prescribe medications such as hormones. Try not to strain during bowel movements because it may cause rectal bleeding. A stool softener can be prescribed if needed. Again, try to drink plenty of fluids to help keep your stools soft. Vigorous exercise and contact sports should be avoided. Short walks are all right. Watch your energy tolerance and recovery – “Don’t push it.” Report any bleeding to your doctor or nurse.
Other side effects you may experience are diarrhea or constipation. There are medications for each of these side effects, so let your doctor or nurse know right away if you have either of them. High fiber foods, prunes or fruit juices may help relieve constipation. It is good to drink at least eight (8 oz.) glasses of fluids each day. A dietitian will also be able to give you other food tips to help relieve these side effects.
Nausea & Vomiting
Chemotherapy can also cause nausea or vomiting. Sometimes, nausea or vomiting may be triggered by certain smells or just thinking about the hospital and about the treatment you will be receiving. Try to keep something, like dry toast or crackers, in your stomach throughout the day. A dietitian can give you other food tips that can decrease the symptoms and help you continue a healthy diet. Strong anti-nausea medications are also available. You should feel free to ask for medication if you feel queasy at any time. Some chemotherapydrugs can cause nausea for an entire day or more after treatment. Therefore, your anti-nausea medication may be continued for a day or so after chemotherapy. Some anti-nausea medications can cause drowsiness so you may need to stop driving while you are taking this medication.
Sore mouth, also called stomatitis, is a common side effect of some chemotherapy treatments. You must keep your mouth as clean as possible to prevent infection. You should rinse your mouth four times each day with a baking soda solution, especially after meals. To make the baking soda solution, mix ½ teaspoon of baking soda to eight ounces of water.
Certain mouthwashes and sprays may be prescribed to prevent infection and to make it easier for you to eat. Do not use commercial mouthwashes because they contain alcohol and may irritate your mouth. You may want to avoid foods or drinks that are tangy, salty or sweet, as they may worsen mouth soreness. Avoid extremely hot foods because they may slow the healing process in your mouth and throat.
Hair loss, both body hair and scalp hair, is a common side effect of chemotherapy. Depending upon the chemotherapy you receive, you may not lose any hair, or it may just become thinner or may completely fall out. Hair loss can have a major impact on body image.
It is natural if you do not want to eat or drink if you have a sore mouth or your stomach is upset, but it is still important that you nourish your body. Your body needs extra calories and protein when you have leukemia to build strong new cells. This is not the time to go on a weight loss diet! If you begin to lose weight, try to eat six small meals or snacks a day and add high-calorie, high-protein foods to your diet. A dietitian will be able to give you more information on these types of food and they are available at your request. A dietitian can also help a family member cope with the loss of pleasant aspects of eating, such as taste, by helping them choose the right foods and preparation style. Your appetite may be stronger in between treatments.
During chemotherapy it is also very important to drink lots of fluids. This means that you should drink at least eight (8 oz.) glasses of fluids each day. You may want to drink fluids that contain calories such as fruit juices, milk or protein supplements. Soft drinks, or carbonated beverages, may increase the intake of carbonation and result in gas or cramping. Soft drinks generally have no nutritional value and juices or energy drinks are preferable. Talk to a dietitian if you are diabetic.
If you cannot tolerate eating regular foods, there are liquid nutritional supplements available to help you get the amount of calories and protein that your body needs. The dietitian can help you choose the correct one.
If you are having difficulty eating, you may receive your nutrients through a tube in your stomach, through an intravenous (IV) line, or through intravenous hyperalimentation (IVH). Both methods can provide you with the nutrients that you need when you cannot eat enough. You will be able to speak with a dietitian if you continue having eating problems and/or weight loss.