Chemotherapy
Most patients with leukemia receive chemotherapy. This type of cancer treatment uses drugs to kill leukemia cells. Depending on the type of leukemia, the patient may receive a single drug or a combination of two or more drugs.
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People with leukemia may receive chemotherapy in several different ways:
The patient may receive the drugs in two ways:
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Some people with chronic myeloid leukemia receive a new type of treatment called targeted therapy. Targeted therapy blocks the production of leukemia cells but does not harm normal cells. Gleevec, also called STI-571, is the first targeted therapy approved for chronic myeloid leukemia.
Biological Therapy
People with some types of leukemia have biological therapy. This type of treatment improves the body’s natural defenses against cancer. The therapy is given by injection into a vein.
For some patients with chronic lymphocytic leukemia, the type of biological therapy used is a monoclonal antibody. This substance binds to the leukemia cells. This therapy enables the immune system to kill leukemia cells in the blood and bone marrow.
For some patients with chronic myeloid leukemia, the biological therapy is a natural substance called interferon. This substance can slow the growth of leukemia cells.
Patients may want to ask these questions about chemotherapy or biological therapy:
Radiation Therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill leukemia cells. For most patients, a large machine directs radiation at the spleen, the brain, or other parts of the body where leukemia cells have collected. Some patients receive radiation that is directed to the whole body. (Total-body irradiation usually is given before a bone marrow transplant.) Patients receive radiation therapy at a hospital or clinic.
These are some questions a person may want to ask the doctor before having radiation therapy:
Stem Cell Transplantation
Some patients with leukemia have stem cell transplantation. A stem cell transplant allows a patient to be treated with high doses of drugs, radiation, or both. The high doses destroy both leukemia cells and normal blood cells in the bone marrow. Later, the patient receives healthy stem cells through a flexible tube that is placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.
There are several types of stem cell transplantation:
Stem cells may come from the patient or from a donor:
After a stem cell transplant, patients usually stay in the hospital for several weeks. The health care team protects patients from infection until the transplanted stem cells begin to produce enough white blood cells.
These are some questions a person may want to ask the doctor before having a stem cell transplant:
Side Effects of Cancer Treatment
Because cancer treatment may damage healthy cells and tissues, unwanted side effects are common. Specific side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, health care providers will explain possible side effects and suggest ways to manage them.
The NCI provides helpful booklets about cancer treatments and coping with side effects, such as Chemotherapy and You, Radiation Therapy and You, and Eating Hints for Cancer Patients. See the “National Cancer Institute Information Resources” section for other sources of information about side effects. NCI’s Web site includes a section called “Coping with Cancer”. This section presents information about coping with fatigue, pain, and other problems.
Chemotherapy
The side effects of chemotherapy depend mainly on the specific drugs and the dose. In general, anticancer drugs affect cells that divide rapidly, especially leukemia cells. Chemotherapy can also affect other rapidly dividing cells:
Some anticancer drugs can affect a patient’s fertility. Women may have irregular menstrual periods or periods may stop altogether. Women may have symptoms of menopause, such as hot flashes and vaginal dryness. Men may stop producing sperm. Because these changes may be permanent, some men have their sperm frozen and stored before treatment. Most children treated for leukemia appear to have normal fertility when they grow up. However, depending on the drugs and doses used and the age of the patient, some boys and girls may be infertile when they mature.
Because targeted therapy (sometimes used for chronic myeloid leukemia) affects only leukemia cells, it causes fewer side effects than most other anticancer drugs. However, Gleevec may cause patients to retain water. This may cause swelling or bloating.
Biological Therapy
The side effects of biological therapy differ with the types of substances used, and from patient to patient. Rashes or swelling where the biological therapy is injected are common. Flu-like symptoms also may occur. The health care team may monitor the blood for signs of anemia and other problems.
Radiation Therapy
Radiation therapy may cause patients to become very tired as treatment continues. Resting is important, but doctors usually advise patients to try to stay as active as they can. In addition, when patients receive radiation therapy, it is common for their skin to become red, dry, and tender in the treated area. Other side effects depend on the area of the body that is treated. If chemotherapy is given at the same time, the side effects may be worse. The doctor can suggest ways to ease these problems.
Stem Cell Transplantation
Patients who have stem cell transplantation face an increased risk of infection, bleeding, and other side effects because of the large doses of chemotherapy and radiation they receive. In addition, graft-versus-host disease (GVHD) may occur in patients who receive stem cells from a donor’s bone marrow. In GVHD, the donated stem cells react against the patient’s tissues. Most often, the liver, skin, or digestive tract is affected. GVHD can be mild or very severe. It can occur any time after the transplant, even years later. Steroids or other drugs may help.
The NCI offers a fact sheet called “Questions and Answers About Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation.” It is available on the Internet at http://www.cancer.gov/publications. Also, information specialists at the NCI's Cancer Information Service at 1-800-4-CANCER can send this fact sheet and answer questions about stem cell transplantation.
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Supportive Care
Leukemia and its treatment can lead to other health problems. Patients receive supportive care to prevent or control these problems and to improve their comfort and quality of life during treatment. Because people with leukemia get infections very easily, they may receive antibiotics and other drugs to help protect them from infections. The health care team may advise them to stay away from crowds and from people with colds and other contagious diseases. If an infection develops, it can be serious and should be treated promptly. Patients may need to stay in the hospital for treatment. Anemia and bleeding are other problems that often require supportive care. Patients may need transfusions of red blood cells to help them have more energy. Platelet transfusions can help reduce the risk of serious bleeding. |
Nutrition
Patients need to eat well during cancer therapy. They need enough calories to maintain a good weight and protein to keep up strength. Good nutrition often helps people with cancer feel better and have more energy.
But eating well can be difficult. Patients may not feel like eating if they are uncomfortable or tired. Also, the side effects of treatment, such as poor appetite, nausea, or vomiting, can be a problem. Foods may taste different.
The doctor, dietitian, or other health care provider can suggest ways to maintain a healthy diet. Patients and their families may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients, which contains many useful ideas and recipes. The “National Cancer Institute Booklets” section tells how to get this publication.
Followup Care
Followup care after treatment for leukemia is an important part of the overall treatment plan. Regular checkups ensure that any changes in health are noted. The doctor can find problems and treat them as soon as possible. Checkups may include a careful physical exam, blood tests, x-rays, bone marrow aspiration, or spinal tap. The doctor can explain the followup plan—how often the patient must visit the doctor and what tests are needed.
The NCI has prepared a booklet for people who have completed their treatment to help answer questions about followup care and other concerns. Facing Forward Series: Life After Cancer Treatment provides tips for getting the most out of medical visits. It describes the kinds of help people may need.
Support for People with Leukemia
Living with a serious disease such as leukemia is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with the disease and the effects of treatment. Patients may want to talk with a member of their health care team about finding a support group. Groups may offer support in person, over the telephone, or on the Internet.
People living with cancer may worry about caring for their families, keeping their jobs, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.
The Cancer Information Service can provide information to help patients and their families locate programs, services, and publications.
The Promise of Cancer Research
Doctors all over the country are conducting many types of clinical trials. These are research studies in which people take part voluntarily. Studies include new methods of treatment and supportive care for patients with leukemia. Research already has led to advances, and researchers continue to search for more effective approaches.
Patients who join these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers take very careful steps to protect their patients.
Researchers are testing new biological therapies and new anticancer drugs, doses, and treatment schedules. They also are working with various drugs and with combinations of drugs, biological therapy, radiation therapy, and stem cell transplantation.
Patients who are interested in being part of a clinical trial should talk with their doctor. They may want to read Taking Part in Clinical Trials: What Cancer Patients Need To Know. The NCI also offers an easy-to-read brochure called If You Have Cancer…What You Should Know About Clinical Trials. These NCI publications describe how research studies are carried out and explain their possible benefits and risks. NCI’s Web site includes a section on clinical trials at cancer.gov/about-cancer/treatment/clinical-trials This section of the Web site provides general information about clinical trials. It also offers detailed information about ongoing studies of leukemia treatment. The Cancer Information Service at 1-800-4-CANCER can answer questions and provide information about clinical trials.
National Cancer Institute Booklets
National Cancer Institute (NCI) publications can be ordered by writing to the address below.
Publications Ordering Service
National Cancer Institute
Suite 3036A
6116 Executive Boulevard, MSC 8322
Bethesda, MD 20892-8322
In addition, people in the United States and its territories may order these and other NCI booklets by calling the Cancer Information Service at 1-800-4-CANCER.
National Cancer Institute Information Resources
You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.
Telephone
Cancer Information Service (CIS)
Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.
Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY (for deaf and hard of hearing callers): 1-800-332-8615
Internet
The NCI's Cancer.gov™ Web site provides information from numerous NCI sources. It offers current information on cancer prevention, screening, diagnosis, treatment, genetics, supportive care, and ongoing clinical trials. It also provides information about NCI's research programs and funding opportunities, cancer statistics, and the Institute itself. Cancer.gov can be accessed at http://www.cancer.gov on the Internet.
Cancer.gov also provides live, online assistance through LiveHelp. Information specialists are available Monday through Friday from 9:00 AM to 10:00 PM Eastern Time. LiveHelp is at http://www.cancer.gov on the Internet.