Treatment of leukemia

Acute leukemia should be treated promptly. Affected by this pathology, people become seriously ill patients, often within just a few days or weeks.

For chronic leukemia The treatment plan depends on how good the patient's condition is at the moment. At the same time, drugs with a targeted effect on tumor cells, as well as chemotherapy, are considered as treatment.

If patients with leukemia have a high risk of recurrence, stem cell transplantation is also considered.

There is no single strategy for the treatment of all leukemia patients, since the forms of leukemia are very different from each other. Patients need an individualized treatment plan that their physicians develop with them.

Here, a number of important questions play an important role, namely:

• Is the disease acute or chronic?
• Is it myeloid or lymphatic leukemia?
• What is the subtype of the disease?
• How good is the general health of the patient?

Treatment of leukemia in Germany: Doctors always follow the current medical guidelines in their treatment. They are published by national and international specialist societies and, based on the current scientific literature, offer an opportunity to get acquainted with those methods that have been recognized as effective and necessary methods of examination and treatment.

Adult patients with leukemia are often offered treatment in clinical trials. In most cases, this is a so-called therapy optimization study: patients are treated in accordance with the latest medical knowledge and recognized therapeutic methods. Small changes are made to the known therapeutic scheme, the purpose of which is to reduce the frequency of side effects and long-term effects. In this way, under controlled conditions, the greatest possible improvement in treatment should be achieved.

Our Cancer Centers are involved in such research, collaborating with Cancer Centers and Universities around the world.

For all patients, it may be interesting to participate in scientific research. Therapy optimization studies improve existing therapies, and other clinical trials test new options and medications.

Acute leukemia: it is important to start treatment quickly.

Depending on the type of leukemia, the number of leukemic cells can increase rapidly within just a few days or weeks. The formation of normal red blood cells, platelets and functionally complete immune cells, on the contrary, is sharply reduced. As a result, formidable symptoms develop in a short time, exposing patients to acute danger.

The treatment of acute leukemia in adults consists of several stages: preliminary induction therapy, consolidating therapy, during which the success of the treatment should be “fixed”, and maintenance therapy aimed at preventing relapses. Immediately after therapeutic measures, dispensary observation begins, during which patients first very often, and then at longer intervals, undergo periodic examinations (with a discussion of their health status with a doctor and important research).

Induction Therapy:

patients receive a combination of different chemotherapy drugs, so-called cytostatics, which are administered intravenously. The goal of this initial treatment is to quickly suppress the progression of leukemia, which often reduces the severity of symptoms in a short time.

In addition to chemotherapy during these first weeks, patients also need supportive measures. These include, for example, the use of antibiotics to prevent infections and the use of drugs to mitigate the side effects of chemotherapy.

Treatment may not always be as intensive as one would like to effectively control leukemia, if patients suffer from any pre-existing diseases, or because of their advanced age, their health is no longer so strong, leukemia treatment should be adjusted accordingly, even if this increases the chance of relapse.

Consolidation Therapy:

patients with acute leukemia are regularly examined to monitor the success of treatment. To do this, doctors take blood and bone marrow samples. If hematopoiesis returns to normal after the first cycles of therapy, patients are not considered to have recovered, but are "in remission."

The second stage of treatment - consolidation - should be directed to those cancer cells that could survive after the first stage of treatment. Consolidating

therapy in most cases lasts from four to six months - depending on the type of disease and the patient's health status. In this case, chemotherapeutic drugs are also used: in successive treatment cycles, various cytostatics are most often combined, which makes it possible to achieve the widest possible therapeutic effect.

Supportive care:

after the second stage, maintenance therapy begins, lasting at least a year and allowing to stabilize the achieved effect. The duration and intensity of maintenance therapy is another subject of clinical research, so patients should discuss with our physicians what this stage of treatment will be like for them. Cytostatics also play an important role during maintenance therapy. New targeted drugs are also being used.

Dispensary observation:

the purpose of dispensary observation is to identify and eliminate the side effects and long-term consequences that occur during treatment, monitor the success of therapy and timely recognition of possible relapses. To monitor the results of treatment, it is necessary to conduct regular blood and bone marrow tests. These studies continue after the end of maintenance therapy. If during such monitoring it is found that the number of leukemic cells increases again, it is necessary to carry out again intensive treatment, for example, the next course of chemotherapy.

If patients with acute leukemia have a very high risk of recurrence, then the so-called stem cell transplantation is considered as another therapeutic option. True, it is associated with risks and numerous side effects. Therefore, stem cell transplantation requires that the overall health of the patient is reasonably good. Such treatment is carried out only in a specialized center under controlled conditions. Depending on the situation, transplantation of donor cells is also possible, or, in exceptional cases, transplantation of one's own "purified" cells.

Scientists and doctors are constantly working to improve medical care for patients with acute leukemia. Thus, in recent years, the influence of changes in the hereditary material of blood cells on the formation of leukemia has become increasingly clear. Researchers are using this knowledge to develop new targeted drugs.

Chronic myeloid leukemias: treatment focused on quality of life

Doctors distinguish chronic myeloid leukemia (CML) from chronic lymphatic leukemia (CLL). Chronic lymphatic leukemia, despite its name, today refers to malignant lymphomas.

After establishing the diagnosis, it is necessary to start therapy as soon as possible: timely treatment can have a beneficial effect on the course of the disease.

With the development of CML, there are three stages of the disease:

• chronic phase
• accelerated phase in which the disease progresses rapidly
• the blast phase (also called the blast crisis phase), in which the disease proceeds like acute myeloid leukemia.

Chronic phase: tyrosine kinase inhibitors

- in almost all patients with CML and in some patients with acute leukemia, leukemia cells show a certain genetic change - the "Philadelphia" chromosome. Patients with this chromosomal defect in leukemic cells can be treated with so-called tyrosine kinase inhibitors and drugs with similar substances. These targeted drugs block the signals necessary for the growth of cancer cells, more precisely, they inhibit the enzymes that play an important role in the transmission of such signals and, therefore, in the metabolism of cells. Today, many relevant drugs are available to medical professionals. They are taken in tablet form. Under the influence of such drugs, the symptoms of the disease are often completely stopped.

Patients in whom the typical "Philadelphia" chromosome is not found often respond less well to treatment with tyrosine kinase inhibitors. Patients need appropriate therapy for each specific case, in which other drugs are also used, in particular interferon, or chemotherapeutic drugs. For such patients, experts especially recommend participation in clinical trials. To monitor treatment outcomes, patients with CML should be monitored regularly. An important indicator is the weakening of the manifestations and symptoms of the disease and, for example, a decrease in the size of the enlarged spleen. To carry out such control, doctors also regularly take blood and bone marrow samples for analysis. In this case, the best option for the patient is the complete disappearance of leukemic cells in the bone marrow and blood.

Acceleration phase

Replacement of used medicines

- the transition of the disease to the acceleration phase can be seen by changing the results of a blood test, an increase in the need for drug treatment, or a deterioration in general well-being. After that, patients most often receive some other drug from the group of tyrosine kinase inhibitors. Thanks to this, the disease often again manages to be transferred to the chronic phase. In such a situation, doctors evaluate whether allogeneic stem cell transplantation can be used as a therapy. With this method of treatment, stem cells are transplanted from the blood or bone marrow of another person. Such therapy can provide remission or even a sustained recovery of the patient, which cannot (or no longer can) be achieved with tyrosine kinase inhibitors. True, this procedure is very risky, and therefore it is often only possible for young patients with a fairly good general health.

Whether or not to have a stem cell transplant is a matter for patients to discuss with their doctor, carefully weighing the expected benefits and possible risks of such treatment.

Blast Crisis: Chemotherapy

The so-called blast phase, or blast crisis, can occur at any time during the illness. It is characterized by an increased percentage of immature cells (called blasts) in the blood, bone marrow, or even in the central nervous system. The condition of patients deteriorates significantly in a short time, and they require urgent medical attention. In most cases, temporary hospitalization is required. The disease in this phase resembles the picture of acute leukemia and is most often treated in the same way as it is: with the help of chemotherapy drugs, they try to suppress the symptoms of the disease as quickly as possible. Only when the disease is under control and the patient's health improves significantly, stem cell transplantation is considered. However, here it should be remembered that this relatively risky therapy is not suitable for every patient.

Myelodysplastic syndrome (MDS): sometimes control is enough

Our team encourages patients to receive treatment whenever possible and be followed up regularly in clinical trials. Whether myelodysplastic syndrome should be treated at all, or whether regular follow-up studies are sufficient, depends on the severity of the symptoms. For a small percentage of patients, regular follow-up may be sufficient. Actually, they are treated only when complaints occur or with a sharp deterioration in the blood picture. For patients who do not have complaints, immediate treatment does not provide any benefits, but brings only side effects. Doctors talk about the strategy "Watch and wait" or "Active surveillance" (translated from English, respectively, "wait and observe" and "active surveillance").

In most patients, pathologically altered cells sooner or later replace normal hematopoiesis. When the diagnosis of myelodysplastic syndrome is established, many patients already have abnormal health conditions. In particular, the most common reason for starting therapeutic measures is anemia (anemia) due to a lack of red blood cells, which impairs the transport of oxygen throughout the body. In patients, this causes increased fatigue and reduces the ability to endure physical exertion.

Symptoms of MDS can significantly impair quality of life. Therefore, in the treatment, the mitigation of aggravating symptoms comes to the fore: complaints about the state of health in patients should be as few as possible. Such supportive care includes, for example, blood transfusions in patients with anemia, or the use of antibiotics if, due to a deficiency of white blood cells, patients are prone to infectious diseases.

Directly for etiotropic therapy aimed at the cause of myelodysplastic syndrome, doctors have at their disposal various chemotherapeutic drugs and targeted medications. A more accurate selection of medicines is carried out taking into account the age and general health of the patient. It is also very important to assess the individual's risk of how quickly the disease progresses and whether it can progress to acute myeloid leukemia. That is why patients are divided into different risk groups. For such a classification, the following criteria are key: how many immature blasts are found in the bone marrow, what genetic changes are observed in these cells, and which blood elements are deficient (red blood cells, white blood cells or platelets).

All patients with a high risk of developing leukemia are evaluated by doctors as early as possible for the possibility of allogeneic stem cell transplantation. It still remains the only treatment that can provide sustainable recovery for people affected by MDS. True, such therapy is fraught with risks and therefore can often be used only in patients with sufficient health for this procedure.