Treatment

Therapy is based on the specific type of cancer and other factors such as a patient’s age, overall health status, gene classification of the disease, and prognosis.

Each type of leukemia uses a slightly different system to determine prognosis and possible treatment:

• ALL classification is based on the type of lymphocyte (B or T cell) and the maturity of the leukemia cell.
• AML prognosis and treatment is based on subtype, a patient’s age, prior chemotherapy/radiation therapy, and the results of molecular testing.
• CLL uses the Rai staging system, which is similar to cancers with solid tumors because it refers to stages as 0 through IV. CLL prognosis and treatment is also determined by the results of molecular testing. 
• CML staging describes progression of the disease in three phases: chronic phase, accelerated phase, or blast phase. 
• CMML is staged as either CMML-1 or CMML-2. 

Some patients’ cases are discussed at a multidisciplinary board — a conference attended by many doctors with different specialties that might be required for your care.

Many types of treatment are used for blood cancers, including chemotherapy, radiation therapy, targeted therapies, immunotherapy, stem cell transplant (bone marrow or peripheral blood), apheresis and surveillance. Blood transfusions, antibiotics, and other medications are also important parts of leukemia treatment.

Chemotherapy

Chemotherapy uses drugs or a combination of drugs — given intravenously or as pills — to destroy cancer cells. It is often the most common treatment for blood cancers.  

• ALL: Chemotherapy is the most common form of treatment for ALL and usually includes a combination of drugs given in three phases typically over the course of about two years. 
• AML: Chemotherapy also is the most common treatment for most types of AML. The most common therapies are cytarabine and the anthracycline drugs, but sometimes other drugs are given based on the type of AML. 
• CLL: Purine analogs, alkylating agents and corticosteroids are groups of chemotherapy drugs frequently used to treat this disease.
• CML: Once the mainstay of treatment for CML, chemotherapy drugs are used less often now that targeted therapies appear to be more successful and have less toxicity.
• CMML: Chemotherapy may be used for CMML when treatment is required. 

Radiation

Radiation therapy uses energy from radiation beams, radio isotopes or charged particles to target tumors and eradicate cancer cells. It is not used very often for leukemia.

Targeted therapy

These are newer drugs designed to target specific gene changes that result in some types of blood cancers. They single out cancer cells and usually have less severe side effects compared to chemotherapy.

• ALL: About one in four adults who have ALL have the Philadelphia chromosome, which means chromosomes 9 and 22 swapped places. These patients may be eligible for targeted therapy drugs called tyrosine kinase inhibitors (TKIs), which are taken as pills and are often used with chemotherapy. 
• CLL: The two main types of targeted therapy for CLL are Ibrutinib and Idelalisib, which are taken in pill form. Targeted therapy with Ibrutinib is being used more and more often to treat newly diagnosed patients as well as patients whose disease has recurred. Wilmot was involved in clinical trials for Ibrutinib, which was found to be more effective than Chlorambucil, a chemotherapy drug that was traditionally used to treat CLL.
• CML: Because of a particular oncogene involved in CML, almost all patients respond well to a targeted therapy drug called Imatinib. Responses last for many years but patients usually have to take the drug indefinitely or their leukemia could return. It comes in pill form. Patients who experience side effects from Imatinib can try other targeted therapies such as Dasatinib and Nilotinib. 
• AML: Wilmot patients with acute leukemia may be eligible for clinical trials in which novel inhibitors target mutations present in their cancer. 

Stem cell transplant

This may involve using high doses of chemotherapy to wipe out cancer cells and decrease the amount of bone marrow in the body. Then, a stem cell transplant helps to restore the healthy bone marrow.

Wilmot’s Blood and Marrow Transplant Program, which is the only such unit in the Finger Lakes region, has been recognized for its high level of care and detailed quality management process. 

• For ALL and AML, many adult patients receive an allogenic stem cell transplant as part of their overall treatment plan. In an allogenic transplant, stem cells are donated from another person whose tissue is a close match.  
• CLL: younger adult patients may receive an allogenic stem cell transplant as part of their treatment.
• For CML, allogenic transplants are used less often because of the success of targeted therapies. However, allogenic stem cell transplantation is the only known cure for CML. A stem cell transplant also may be offered as an option to patients who’s CML comes back after targeted therapy or whose disease does not respond to targeted therapy. 

Immunotherapy

This is a newer type of treatment that attacks cancer by boosting the patient’s own immune system or by using immune proteins to target the cancer cells. It is being studied and used in some cases to treat many different types of blood cancers, including leukemia and myeloma.

A new type of immunotherapy treatment — known as chimeric antigen receptors (CAR) T-cell therapy — is being studied in clinical trials. Wilmot is part of a select group in the northeastern U.S. with access to clinical trials for CAR T-cell therapy for lymphoma and in the near future for acute lymphoblastic leukemia (ALL). Eventually CAR T-cell therapy might be used for myeloma and other types of leukemia.   

Other types of immunotherapies for leukemia:

• ALL: A drug called Blinatumomab can be used to treat B-cell types of ALL. It’s given continuously by vein for 28 days. 
• CLL: There are two types of monoclonal antibodies used to treat CLL. One type targets the CD20 antigen and another type targets the CD52 antigen.  
• CML: Interferon can help reduce growth of leukemia cells. It requires a daily injection under the skin. It was once the main treatment for CML but today, targeted therapies are more often used because they tend to be more successful.
• AML: Wilmot patients may be eligible for clinical trials in which new immune therapies target proteins on the surface of the cancer cells.
• Myeloma: There are two types of monoclonal antibodies used to treat patients whose disease has recurred after initial treatment.

Surveillance

For slower growing blood cancers, watchful waiting may be the best route. This involves oncologists carefully monitoring patients with frequent visits to ensure the cancer hasn’t become more threatening.

Supportive care

This type of therapy can ease symptoms caused by leukemia. It includes infection prevention or treating developed infections using antibiotics, anti-virals or other medications. Transfusions of red cells and platelets can also be part of supportive care.

Side effects

Many cancer treatments cause side effects such as hair loss or fatigue, but not everyone experiences side effects the same way.

Wilmot's Cancer Control & Survivorship program is one of the oldest and most highly regarded research programs in the country to investigate the management of side effects, including cancer-related fatigue.

The American Cancer Society also offers free online resources to help patients manage the side effects of their illness.