How Do You Treat Leukemia?

“He was so stoic, he scared the doctor,” his mother remembered. “He just sat there and took it.” This is how Isaiah’s mother described her son’s reaction to the ordeal of treatment for leukemia. Isaiah, a young Alaska Native, underwent intensive chemotherapy to put his cancer into remission. After his leukemia was in remission a bone marrow transplant was required to help replenish the healthy blood cells destroyed by chemotherapy.*

Isaiah received the same treatment that many others suffering from acute leukemia receive—chemotherapy followed by a bone marrow transplant. Rapid advancement and new discoveries in leukemia treatment have made surviving leukemia more likely than it was in the past. Other options for treatment include radiation, biological therapy and in rare cases, surgery.

Deciding which treatment route to go can be complicated. The decision is based on the type and extent of the disease as well as certain features of the leukemia cells. In addition, the health of the patient must also be taken into account. For example, factors such as age, symptoms, and overall health are evaluated to determine the best treatment.

Acute Leukemia

One of the most common types of leukemia, acute leukemia, must be treated right away because of how quickly the cancer progresses. The main objective of treatment is to bring about remission, leaving no trace of the disease. During remission, more therapy is given to the patient to prevent relapse. When treated early, many people with acute leukemia are cured.

Chronic leukemia

The second most common type of leukemia, chronic leukemia, may not require immediate treatment because disease progression is slower. However, it is imperative for those with this type of leukemia to have frequent checkups in order to monitor the disease. When treatment is needed it is often used to control the disease and symptoms.

	Chemotherapy is given in cycles, a treatment period followed by a recovery period, then another treatment period and so on. Anticancer drugs reach all areas of your body through your bloodstream. Chemotherapy destroys cancer cells by stopping them from growing or multiplying. Some healthy cells are destroyed as well, which is what causes the side effects, but normal cells are often able to repair themselves after treatment. Different types of drugs are used for the different types of leukemia.
Biological therapy is treatment with substances that affect the immune system's response to cancer. Interferon, a drug used against some types of leukemia, is a form of biological therapy. Biological therapy or immunotherapy uses the body’s immune system to fight cancer, using antibodies to target and destroy leukemia cells
	Surgery is less likely to be considered for sufferers of leukemia because leukemia cells are spread throughout the body making it difficult to target one specific area. However, in some cases surgery is done to remove the spleen. The spleen may be removed because blood cells have accumulated, causing the spleen to swell and displace other organs in the abdomen.
Radiation is treatment with high-energy rays that destroy cancer cells. Sometimes it is used for leukemia in the central nervous system or testicles as well as for pain caused by bone destruction. However, radiation is not the primary treatment for leukemia. In high doses radiation therapy kills cells or keeps them from growing and dividing. Radiation therapy is helpful in treating cancer because cancer cells reproduce faster than most normal cells. Although radiation does kill normal cells along with the cancer cells.
	Bone Marrow Transplants (Fig. 1) are probably the best bet for a cure in many cases of leukemia. Doctors perform this procedure when leukemia is in remission or when the patient relapses during or after treatment. Patients are given a bone marrow transplant so that their body can be given higher doses of chemotherapy drugs that would not be tolerated otherwise. Chemotherapy destroys cancer cells but it also kills normal cells in the bone marrow, making the bone marrow transplant necessary in order to make up for the destruction of normal cells.
Fig. 1 Bone marrow is removed from the donor’s hipbone with a syringe and then injected into the leukemia patient.
Innovative treatments with exciting results are available to patients. Just recently researchers conducted a clinical trial using a new drug, STI-571, which offer greater hope for those who suffer from chronic myelogenous leukemia. In the past patients with chronic myelogenous leukemia had a low survival rate, less than 20 percent according to the Oregon Cancer Center Leukemia Program. This special new drug is a pill that patients take daily, however it is different from chemotherapy in that it does not kill healthy cells along with the cancer cells. STI-571 specifically targets an enzyme found only in leukemia cells, therefore patients suffer fewer side effects. In the tests done by Dr. Brian Druker associate professor of medicine at Oregon Health Sciences University, 19 of 29 patients responded positively to therapy, meaning their bone marrow cell abnormalities were reduced to 15 percent.

Curing leukemia is a difficult battle to endure, however there is hope. With recent developments in cancer treatment, new and better ways to fight leukemia are available. The most common treatment includes chemotherapy followed by a bone marrow transplant. However, an important dilemma facing Native Americans is the lack of bone marrow donors in the Bone Marrow Donor Program registry, which has only 1% Native Americans.

Fortunately, Isaiah’s sister had the same tissue type as her brother, and so Isaiah underwent a bone marrow transplant. “Seeing what my brother went through, it was nothing,” his sister explained of the donation procedure. *

Siblings are the most likely to be a tissue match however, that happens only 30% of the time. In most cases leukemia patients must rely on someone else to help them.

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*This story was adapted from “A Common Pain: Native Families Increasingly Feel the Impact of Cancer.” By Diana Campbell