Other Treatments for Leukemia

June 10, 2008 - 7:30am

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Other Treatments for Leukemia

Other types of treatment that may be used for leukemia include the following:

]]>Blood transfusions]]>
]]>Leukapheresis]]>
]]>Biologic therapy: Interferon]]>
]]>Targeted molecular therapy: Gleevec]]>
]]>Bone marrow transplantation]]>

Blood Transfusions

In patients who are short of breath, fatigued, or in danger of serious bleeding, a blood transfusion may be done. In this procedure, red blood cells, platelets, or other blood components are infused into a vein to increase the levels of these blood components back to within the normal range.

Prior to a transfusion, your blood will be drawn to check your blood type. Donated blood must be matched to your blood type, although you may receive blood that is not exactly the same as your type. You may receive blood that has been irradiated (to prevent the risk of graft vs. host disease, a condition where the transplanted cells can attack your tissue) and filtered to reduce the number of leukocytes in the transfused blood. A nurse will monitor you for any signs of an adverse reaction.

Effectiveness of Blood Transfusions

Blood transfusions serve to restore some of the components missing from the blood. It is not a curative treatment. You may need multiple blood transfusions during the course of this disease. The transfusion of blood often is highly effective in alleviating acute symptoms caused by the low level of either red blood cells or platelets.

Side Effects of Blood Transfusions

The main side effect of a blood transfusion is an allergic reaction. Such a reaction may produce the following symptoms:

Fever and chills
Shortness of breath
Wheezing
Chest and/or back pain
Nausea and vomiting
Hives
Itching
Swelling
Dizziness
Headache
Muscle spasm
Blood in the urine
Kidney problems

Leukapheresis

Leukapheresis is a therapy to remove leukocytes from the blood in patients with acute leukemia who have high numbers of immature cells (blasts) in the blood. Patients with high numbers of these cells are at risk for severe brain hemorrhage or stroke-like symptoms.

In this procedures, blood is removed from your body and run through a machine, which selectively filters and removes the leukocytes. The rest of the blood is returned to the body. It is typically done every day for a certain period of time, until there is no further danger from the high number of cells. Often, leukapheresis is combined with medications like hydroxyurea to control the production of blasts, and radiation to the brain to decrease the risk of cerebral bleeding. Leukapheresis may also be done at the start of therapy, while waiting for the chemotherapy]]> to begin to decrease the number of malignant cells.

Effectiveness of Leukapheresis

Leukapheresis helps manage leukostasis syndrome, a medical emergency that occurs when too many leukocytes prevent blood flow to the small vessels of a vital organ or the brain. Leukapheresis is not a curative treatment.

Biologic Therapy: Interferon

Biologic therapy is a treatment that uses drugs to improve the way your body’s immune system fights disease. Your immune system is your body’s natural defense against disease. A healthy and strong immune system can detect the difference between healthy cells and cancer cells. Biologic therapy attempts to repair, stimulate, or enhance the immune system so that it can fight the cancer more effectively. These therapies can be used to fight cancer or to lessen the side effects that may be caused by some cancer treatments.

Recombinant interferon-a is a type of biologic therapy that is used to treat leukemia. This drug is often used to treat chronic myeloid leukemia. It is given by injection, and is often used in combination with chemotherapy. It stimulates the immune system to fight the cancer.

Effectiveness of Interferon

Clinical remission rates for interferon used for CML are reported to be as high as 70% to 80%. Only a minor fraction of these patients achieve a cytogenetic (molecular) remission. Interferon can increase survival by about 20 months.

Side Effects of Interferon

The side effects of interferon include fever, chills, headache, malaise, loss of appetite, vomiting, joint and back pain, muscle aches, and mood changes. About 30% to 40% of patients with CML are not able to tolerate interferon.

For a thorough discussion of interferon and other biologic therapies, see the biologic therapy treatment monograph]]> .

Targeted Molecular Therapy: Gleevec

Imatinib mesylate (Gleevec, STI-571) specifically attacks the leukemia cells while sparing normal cells. Gleevec is the first of what is likely to be many specific drugs that work by attacking known important mutations or pathways in a cancer cell.

Gleevec may be given after interferon or if chemotherapy]]> regimens fail to maintain remission. It is taken orally with food and a large glass of water. You will take this drug as long as it continues working, unless you develop unacceptable side effects.

Effectiveness of Gleevec

According to the FDA, Gleevec has been show to produce responses in 31% of patients in blast phase and 93% of patients in the chronic phase who are not responding to interferon. Gleevec specifically targets the mutation that is characteristic of CML leukemic cells, and although remissions are very likely, the long-term durable remission rate and cure rate is uncertain.

Side Effects of Gleevec

Gleevec may cause the following side effects:

Fluid retention
Swelling in tissues
Fluid in the lungs
Nausea, vomiting, diarrhea
Muscle cramps
Bleeding
Changes in the blood counts
Decreased liver function

Bone Marrow Transplantation (BMT)

Bone marrow is a soft, sponge-like material found inside certain bones, such as the heads of the femur and humerus, the sternum, and the hip bones. Bone marrow contains immature cells called stem cells. Stem cells can mature into blood cells (white blood cells, red blood cells, and platelets), which are often damaged by cancer.

For a stem cell transplant, stem cells from the peripheral blood or bone marrow are collected (harvested) and placed in frozen storage prior to treatment of the cancer with high-dose chemotherapy. Once chemotherapy treatment is complete, the stem cells are put back into your body; they enter your blood stream and travel to your bone marrow where they replace damaged stem cells and begin to make healthy blood cells. If your own stem cells are used the transplant is called autologous. If a donor's cells are used, it is called and allogeneic transplant.

Using cells from a donor, the risk of death from graft vs. host disease increases with age. Using the patient’s own cells decreases the risk of death from the procedure, but relapse rates are higher.

BMT for Acute Leukemia

In acute myeloid leukemia (AML), bone marrow transplantation is usually done at the first sign of a recurrence after chemotherapy]]> . Patients older than 60 with AML may not be candidates for this procedure, but standards are changing as the procedure becomes more tolerable. Some patient with acute leukemia who have a poor prognosis are offered BMT after initial remission, if relapse is likely.

Bone marrow transplantation, using donor cells, may be done for adults with acute lymphoid leukemia. It is usually not considered for children, who typically respond well to intense chemotherapy regimens.

BMT for Chronic Leukemia

For chronic myeloid leukemia (CML), stem cells are collected from a donor. Siblings with matching blood characteristics make the best donors. If the patient does not have a matched sibling, it may be difficult to find a donor. Transplants are usually offered to younger patients, while older patients may receive drug therapy. There is some evidence that success of transplant is higher when done in the first year following diagnosis.

Because chronic lymphoid leukemia usually occurs in older adults, bone marrow transplantation is usually not an option. In younger patients, donor cells and those harvested from the patient have been used.

Effectiveness of BMT

Some facilities report success rates reaching 40% or more for AML using a donor’s cells. About half of patients receiving BMT will relapse.

Adults with ALL may experience long-term disease-free survival rates of 40% or more when bone marrow transplantation is performed with cells from a donor.

About 15% or 20% of CML patients in the blast phase achieve long-term remissions.

The majority of patients with CML who do not have a serious or fatal complication from transplantation will remain cured of their leukemia.

Special Considerations

Bone marrow transplantation is a very intense therapy. Death may occur in as many as 30% to 40% of patients as a complication of therapy. For diseases like CML and CLL, this makes discussion of timing and use of this type of treatment complicated. Discuss the risks and benefits with your physician.

When to Contact Your Health Care Provider

Call the doctor if your develop any of the following:

Signs of infection, such as fever, cough, runny nose, red or swollen skin
Signs of abnormal bleeding

Sources:

National Cancer Institute

American Cancer Society

The Leukemia & Lymphoma Society

Bast R, et al. Cancer Medicine e5 . Hamilton, Ontario: B.C. Decker Inc.; 2000.

Abeloff M. Clinical Oncology , 2nd ed. Orlando, FL: Churchill Livingstone, Inc.; 2000: 486-490 and 2658-2701.

Last reviewed February 2003 by ]]>John Erban, MD]]>

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.