leukemia treatment | Treatment of leukemia

Treatment of leukemia

The treatment of leukemia can go through chemotherapy. However, the treatment of acute leukemias in the treatment of chronic leukemia is distinguished. Another possibility is the donation of bone marrow. In any case, a relapse is possible.

Different treatments for different leukemias
The treatment of leukemia can vary greatly according to the leukemia in question and according to the characteristics of the patient. Schematically, it can be summed up by saying that:

The treatment of acute leukemias is done by intensive chemotherapy, usually with:
A first phase of induction for healing;
A second phase of consolidation designed to limit the risk of relapse (or to contain the evolution of the disease if it cannot be eliminated);
In case of acute lymphoblastic leukemia, additional radiation from the base of the skull which can be prescribed to avoid contamination of the central nervous system.
Chronic myeloid leukemias associated with the Philadelphia chromosome can be treated specifically by drugs targeting this genetic anomaly (which greatly improves prognosis).
Chronic lymphoid leukemias:
Diagnosed early and not evolving can be placed under surveillance;
That progress or cause severe symptoms require the implementation of treatment.
Some chronic leukemias require a donation of bone marrow to be able to perform a marrow or stem cell transplant, especially in younger patients, if the initial treatments have proved insufficient.
In any case, to improve the prognosis of leukemias a very fast management is indispensable.

Choice of treatment for leukemia: a multidisciplinary approach
Since several approaches are possible, what are the bases on which the choice of a particular leukemia treatment is made?

As a first step, emergency treatment is put in place as soon as a patient is hospitalized.
Then the medical team will come together and take into account all the data of the problem:
Test results
General health of the patient
or non-evolutionary nature of leukemia, etc.
To finalize the choice, it is based on a whole set of factors that a suitable treatment can be proposed. This is only possible by taking into account the information available to several specialists (hematologist, oncologist, biologist, nurse, psychologist, etc.). This is a multi-disciplinary choice made in conjunction with the attending physician where possible.
Once the treatment program is established, the hematologist transmits it to the patient. The final choice is made by the latter. It is only a proposal for treatment and the doctor must take into account the patient's opinion and obtain the consent of the latter.

Note: It is sometimes suggested that the patient participate in a clinical trial (a study in which new methods are evaluated) in order to test new therapeutic approaches, to find better methods of prevention, detection and Cancer treatment.

Support Care
The treatment of leukemia is accompanied by supportive care. This is an aid designed to support the patient and his entourage in order to cope with the consequences:

Of the disease (emotional difficulties, infections, bleeding...);
of his treatment (fatigue, loss of appetite...), because living with leukemia is never an easy thing.
Different health professionals are likely to intervene and more specifically psychologists and social workers. They can work at the hospital on which the patient depends, but also in the office, go to his or her home or participate in a patient association. Their role is multiple:

Stakeholders are responsible for the follow-up that is proposed, if necessary, to help the patient maintain or regain a psychological, relational and professional balance.
It is also a matter of detecting and taking care of the late side effects induced by the treatment.
Finally, this support allows to detect the first signs of a possible relapse, in particular by ensuring the follow up with the establishment of blood and myélogrammes at regular intervals.

Advances in research to treat leukemia

Research in the field of cancer treatment and leukemia in particular is continuing actively. So new therapeutic options are now being seen:

This is in particular the case of a molecule, quizartinib, which has definitively cured 44% of patients with acute leukemia with a particular mutation (FLT3-ITD) and who were in the relapse of chemotherapy or transplant of stem cells.

Similarly, in 98% of chemo-resistant patients (of which 50% had chronic myeloid leukemia), ponatinib was able to decrease the rate of leukemic cells to the point of making them undetectable.

Furthermore, another team of researchers has developed a molecule, compound G, which can cause death by self-eating of leukemic cells (they can be digested). Interestingly, this molecule affects only the diseased cells and proves to be free of toxicity to normal cells.

In the same vein, researchers found that by depriving the cells responsible for acute myeloid leukemia, they stopped multiplying before they died. The process is greatly increased if vitamin D is added. The result is interesting: the life expectancy of the patients who participated in the clinical trial was multiplied by 2 and the side effects were very limited.

In 2017, the US drug agency (FDA) approved the placing on the US market of a drug based on the CAR-T cell technology, consisting of using the patient's own genetically modified immune cells to destroy Tumor cells. Thus, Kymriah (Novartis) allows a remission in 83% of patients with a very aggressive form of leukemia in children and young adults.

Good to know: the application for authorisation to put on the European market of this last medicinal product is in progress with a possible access to this treatment from 2018. However, even if only one injection is sufficient, it is currently charged between 373 000 and 475 000 in the United States. On the other hand, side effects are very important (fever, respiratory problems, drop in tension, confusion, convulsions, etc.).