The treatment of acute leukemia is usually based on two successive chemotherapies:
- a chemotherapy called “induction” whose purpose is to remove the abnormal cells of the bone marrow and blood of the patient, as well as to remove the symptoms of the disease;
- a chemotherapy of “consolidation” whose objective is to avoid relapse. It is often followed by an “intensification” treatment combining chemotherapy and bone marrow transplantation. The drug treatment eliminates the last blast cells and promotes the success of the transplant.
This general strategy may be different in certain leukemia for which there are very specific treatments.
Treatment of acute myeloid leukemia
The induction treatment by United Energy Workers Healthcare lasts several days. It corresponds to a multidrug therapy, that is to say a combination of several anticancer drugs. This treatment aims at destroying the leukemic cells but it also destroys, transiently, the normal cells of the marrow and the blood. For three to four weeks, the patient no longer has white blood cells to defend against infectious agents or platelets to prevent bleeding. We are talking about a state of bone marrow depression. The patient should receive platelet and globular transfusions, and anti-infection measures, including isolation, should be taken. Its bone marrow will then regenerate and normal amounts of white blood cells will be found.
Doctors monitor the effectiveness of induction therapy by monitoring the disappearance of abnormal cells in the myelogram. When this disappearance is complete, consolidation chemotherapy begins. The treatment protocols used are chosen according to the age and risk of recurrence of the patient. Their pace of administration is usually monthly. Most often, the patient can return home between treatments. Some of these treatments may even be administered by a nurse at the patient’s home.
Subsequently, the treatment envisaged depends on the patient: maintenance chemotherapy can be offered in the long term. It should be lightened for people in poor condition and particularly elderly subjects. In some patients under 60 years of age who are in good general condition and whose leukemia is at high risk of recurrence, a bone marrow or stem cell transplant can be performed.
The transplant is a complex therapy requiring a donor and long hospitalizations. Thanks to the many advances made in this area, this treatment traditionally reserved for people under 50 is now conceivable for older patients.
Treatment of acute lymphoid leukemia
An induction cure by United Energy Workers Healthcare is conducted to obtain a complete disappearance of the diseased cells. Several courses of consolidation succeed him. Then, depending on the prognostic factors, the quality of response to the induction treatment and the profile of the patient, the doctor offers long-term maintenance chemotherapy or a hematopoietic stem cell transplant.
In acute lymphoid leukemia, there is a significant risk of passage of leukemia cells into the central nervous system. Preventive treatment is given to all patients to limit this risk. At the same time, radiotherapy of the base of the skull is prescribed.It takes place in several sessions of rays. Lumbar punctures, that is to say the collection of a cerebrospinal fluid sample by puncture in the vertebral column between the vertebrae, make it possible to regularly check the absence of leukemic cells in the central nervous system. .
Treatment of chronic myeloid leukemia
If the genetic abnormality causing chronic myelogenous leukemia (the Philadelphia chromosome) has been known for several decades, it was only in the late 1990s that a drug targeting this anomaly could be to the point: imatinib. Since then, two new molecules have been developed: dasatinib and nilotinib. These three drugs are extremely effective since they allow obtaining a complete disappearance of the abnormal cells. We speak of “haematological, cytogenetic and molecular remission”. In addition, they are administered orally and have exceptional tolerance: they generally do not cause nausea, vomiting, or hair loss. Serious side effects occur in less than 1% of patients. This generation of new treatments has completely upset the prognosis of the disease that was still bad a few years ago. Chronic myeloid leukemia is now considered a chronic disease, with which it is possible to live practically normally for very long years.
However, resistance to these new drugs is observed in a small fraction of patients. Sometimes it only affects one or two of the three available molecules. Other times, it is necessary to return to the old treatment (combining interferon and cytarabine), less effective and resulting in more side effects.
Finally, as effective as these drugs are on the disease, the current data do not allow to determine if the cure itself is possible. The risk of relapse still exists. Therefore, especially in younger patients, allogeneic hematopoietic stem cell transplantation may be proposed in case of insufficient efficacy of the initial treatments.