This means that treatment may not be as aggressive in the earlier stages, leaving room for emerging options like targeted therapies. Researchers believe that targeted therapies may work so well in early CML that survivors may enter remission and achieve a typical life expectancy. Based on the success of targeted therapies for CML, researchers are looking at whether people can stop taking these drugs during remission.
Currently, targeted therapies are meant to be taken for the rest of your life. ALL makes up the majority of childhood cancers. While early treatment may be more successful than with the other major acute form of leukemia AML , ALL can still spread quickly. Your body already has T-cells , but when you have cancer, they may not work as they should.
With CAR T-cell therapy, some T-cells are removed and genetically modified with receptors to fight cancer more effectively. CAR T-cell therapy is also being researched as a substitute for more toxic treatments for adult ALL, such as chemotherapy. Researchers also hope it will someday replace stem cell transplants in older adults with B-cell ALL.
Newer treatments for CLL include targeted therapies, especially in combination form. CAR T-cell therapy is also being investigated as a possible treatment for this type of leukemia. But researchers are currently testing different targeted therapies to treat this type of leukemia. To prevent side effects of chemotherapy or radiation therapy, a doctor may try targeted therapies first.
Acute leukemias are more typical in babies and children than slow-growing versions. For this reason, standard treatments tend to include:. Due to the risk of lifelong side effects, researchers are looking into other options, such as targeted therapies and immunotherapies.
A drug called sorafenib Nexavar is being investigated as a possible treatment to be taken alongside chemotherapy to weaken the side effects. Aside from more potential targeted therapies, researchers are also looking at gene fusions that may be taken with these medications.
Here are some ideas that may help you cope with the effects of leukemia and its associated treatments:. Talk to a doctor about the possible side effects of newer forms of immunotherapy or targeted therapy for leukemia. If you take immunotherapy intravenously, you may experience reactions at the injection site, including:. The overall 5-year survival rate for leukemia is estimated at As new, earlier treatments have emerged, the death rate for this type of cancer is also declining.
In , leukemia made up only 3. Acute types of leukemia may impact your outlook, as these tend to progress more quickly. This typically lasts for a few months. Usually the drugs are given in high doses so that the treatment is still fairly intense.
A targeted drug like imatinib is also continued for patients whose leukemia cells have the Philadelphia chromosome. Some patients in remission, such as those who have certain subtypes of ALL or other poor prognostic factors, are still at high risk for the leukemia relapsing coming back.
Instead of standard chemo, doctors may suggest an allogeneic stem cell transplant SCT at this time, especially for those who have a brother or sister who would be a good donor match. An autologous SCT may be another option. Patients considering this procedure should think about having it done at a center that has done a lot of stem cell transplants. After consolidation, the patient is generally put on a maintenance chemotherapy program of methotrexate and 6-mercaptopurine 6-MP.
In some cases, this may be combined with other drugs such as vincristine and prednisone. For ALL patients whose leukemia cells have the Philadelphia chromosome, a targeted drug like imatinib is often included as well. Maintenance usually lasts for about 2 years.
This means leukemia cells can no longer be seen in their bone marrow. Again, these rates can vary a lot, depending on the subtype of ALL and other prognostic factors.
For example, cure rates tend to be higher in younger patients. A stem cell transplant may be tried if the leukemia can be put into at least partial remission. Clinical trials of new treatment approaches may also be considered. If leukemia goes into remission with the initial treatment but then comes back relapses or recurs , it will most often do so in the bone marrow and blood.
Occasionally, the brain or spinal fluid will be the first place it recurs. In these cases, it is sometimes possible to put the leukemia into remission again with more chemotherapy chemo , although this remission is not likely to last. The approach to treatment may depend on how soon the leukemia returns after the first treatment. If the relapse occurs after a long interval, the same or similar treatment may be used to try for a second remission.
If the time interval is shorter, more aggressive chemo with other drugs may be needed. Immunotherapy might be another option for some patients. ALL patients with the Philadelphia chromosome who were taking a targeted drug like imatinib Gleevec are often switched to a different targeted drug. If a second remission can be achieved, most doctors will advise some type of stem cell transplant if possible. If a stem cell transplant is not an option, a patient may want to consider taking part in a clinical trial of newer treatments.
It's given over a longer period of time two to three years , but its aim is the same: to destroy remaining cancer cells. In most of the acute myeloid leukaemias, the role and duration of maintenance chemotherapy is still being studied. In many people it isn't currently used. In general, this phase of treatment isn't as intense as the first two phases. It may sometimes be replaced by stem cell bone marrow transplantation after high-dose chemotherapy.
The most important effect of chemotherapy is that it kills leukaemia cells. However, it may have side effects. Normal cells are better able to renew themselves after chemotherapy than leukaemia cells, but some normal cells which multiply rapidly such as hair cells and normal blood cells may be affected by chemotherapy.
Reactions vary with different drugs, with different people and from one course of treatment to the next. Doses of chemotherapy which are moderate, such as those used for treatment of chronic leukaemia, usually cause few side effects. The most common side effects are nausea and vomiting, feeling off-colour and tired, hair loss, diarrhoea, constipation and a sore mouth. If normal blood cells are affected, you may also have problems with infection and bleeding.
Tell your doctor if you have any of these side effects. Imatinib Glivec is being increasingly used to treat chronic myeloid leukaemia. It's sometimes added to chemotherapy to treat a type of acute lymphocytic leukaemia. Its side effects include mild feelings of sickness, diarrhoea, leg aches and cramps, rashes, and swelling around the eyes.
All-trans retinoic acid, used to treat a type of acute myeloid leukaemia, may cause headaches, bone pain and dry skin.
Remember that side effects can be prevented or controlled. Ask for advice on any possible reactions you may have and the best ways for you to cope with them. This treatment allows you to have higher doses of chemotherapy than usual. This may increase your chance of being cured.
It can be exhausting and has significant risks. Newer forms of transplantation called mini allografts or reduced-intensity allografts use lower doses of chemotherapy. They attempt to use the immune system to fight the leukaemia. For some younger patients with acute leukaemia in remission this treatment greatly increases the chance of long-term remission and cure.
Stem cell transplantation is rarely used as the first treatment for children with acute lymphocytic leukaemia because chemotherapy usually works very well. Stem cells grow in bone marrow the soft tissue inside bones. They're immature cells, from which essential new cells for the body grow. High doses of chemotherapy can harm stem cells. So if you need high dose chemotherapy, and your doctor thinks you're strong enough, this treatment can put healthy stem cells into your body after the chemotherapy.
Stem cells can be taken from blood this is called peripheral stem cell transplantation or directly from bone marrow this is called bone marrow transplantation. The stem cells will either come from you before your chemotherapy autologous donor or from a donor whose stem cells closely match yours allogeneic donor.
You or the donor may have injections of a growth factor beforehand. This stimulates the bone marrow to produce large numbers of stem cells for collection.
You or the donor will have blood taken by syringe from a vein usually in your arm or from a small tube going through a vein in your neck or chest. The blood goes through a machine that spins the cells at very high speed. A computer is used to separate the stem cells, which are placed in a collection bag.
If your own stem cells are taken, the remaining blood cells will be returned to your body. An anticoagulant will prevent the blood clotting; it may cause a tingling in your fingers or lips. Let the nurse know if this happens and changes can be made. Sometimes, stem cells are taken from the bone marrow in the hipbone or breastbone. This is done in an operating theatre under general anaesthetic. The stem cells will be put in your body after your high dose chemotherapy. It's like a blood transfusion.
The cells will find their way into the bone marrow. This will eventually result in normal blood cell numbers. This can take some time. While you're in hospital you'll have a range of treatments aimed to help the treatment work. While you're waiting for the treatment to work, you'll be prone to infections. You may bruise and bleed more easily, and may become weak, with little energy. Other possible side effects include mouth infection and ulcers, nausea, vomiting, diarrhoea or bleeding from the bladder.
Let your nurse and doctor know if you have any of these symptoms so they can be treated. Generally, when this happens, it causes mild symptoms, but sometimes GVHD can be a serious illness. Discuss the risks with your doctor if you're going to have an allogeneic transplant. Interferon is a protein that's normally made by the body and has anti-cancer effects. It used to be used to treat chronic myeloid leukaemia but this is less common now. You'll have interferon by daily injection under the skin.
You may learn how to give yourself the injections, or they may be given by someone living with you, or by a visiting nurse. Interferon can cause flu-like symptoms fever, chill and sweats one to two hours after the injection. Some people have the injection before they go to bed, so these symptoms don't interfere too much with day-to-day life.
Other side effects include tiredness, loss of appetite and muscle pain. Interferon can also affect blood counts just like chemotherapy and you'll need regular blood tests. This is a form of vitamin A used to treat a type of acute myeloid leukaemia called acute promyelocytic leukaemia. It's usually taken in tablets with chemotherapy. Some people have headaches, dry skin, dry mouth and bone pain while taking this treatment. For information about specific treatments and treatment by stage of leukaemia see the Leukaemia Foundation website.
The prognosis for people with all forms of leukaemia is improving all the time, with better understanding of the disease and new treatments. Most children and many adults with acute leukaemia can expect to be cured with modern treatments. Even people who aren't cured usually have prolonged remission and normal lives for the duration of their remission. For most people, chronic leukaemias can be controlled and normal life enjoyed for long periods of time. Treatment for chronic myeloid leukaemia gives prolonged remission in most people and new treatments are curing many people.
Patients with early stage chronic lymphocytic leukaemia may never need treatment. Many people want to know about the risk of their leukaemia returning or relapsing. Everyone is different, so it's usually not possible to give definite answers. Factors such as the type of leukaemia you have, your symptoms and your age all affect your prognosis, so it's best to discuss your situation with your doctor. Your doctors may want to examine you every 3 months for the first year after your treatment, every 6 months between the second and fifth years of your treatment, and once a year after that.
They'll examine you and ask about any symptoms you've had, and will answer any questions you have. Your doctor may order other tests or scans if they think they're needed. After treatment for leukaemia you're likely to face several changes in your life. For some people these changes may be short term. Other changes may be permanent and difficult to cope with.
Most people find they need information and support about how to best deal with their situation. For more information see the links below or contact Cancer Council on 13 11 20 to speak with a cancer nurse. Call or email our experienced cancer nurses for information and support.
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