Blood Cells See Blood and Blood Disorders Treatment 

Most forms of leukemia are treated with pharmaceutical medications. Some are also treated with radiation therapy. In some cases,  a bone marrow transplant is useful.
Acute lymphocytic leukemia (ALL) 

Further information: Acute lymphoblastic leukemia#Treatment 

Management of ALL focuses on control of bone marrow and systemic (whole-body) disease. Additionally, treatment must prevent leukemic  cells from spreading to other sites, particularly  the central nervous system (CNS) e.g. monthly lumbar punctures. In general, ALL treatment is divided into several phases 

• Induction chemotherapy to bring about  bone marrow remission. For adults, standard induction plans include prednisone, vincristine,  and an anthracycline drug; other drug plans may include L-asparaginase or cyclophosphamide. For children with low-risk ALL, standard therapy usually consists  of three drugs (prednisone, L-asparaginase, and vincristine) for the first month  of treatment. 
• Consolidation therapy or intensification therapy to eliminate any remaining leukemia cells. There are many different approaches to consolidation, but it  is typically a high-dose, multi-drug treatment that is undertaken for a few months. Patients with low- to average-risk ALL receive therapy with antimetabolite drugs such  as methotrexate and 6-mercaptopurine (6-MP). High-risk  patients receive higher drug doses  of these drugs, plus additional drugs. 
• CNS prophylaxis (preventive therapy) to stop  the cancer from spreading to the brain and nervous system  in high-risk patients. Standard prophylaxis may include radiation of the head and/or drugs delivered directly into the spine. 
• Maintenance treatments with chemotherapeutic drugs to prevent disease recurrence once remission has been achieved. Maintenance therapy usually involves lower drug doses, and may continue for up to three years. 
• Alternatively, allogeneic bone marrow transplantation may be appropriate for high-risk or relapsed patients. 

• falling hemoglobin or platelet  count
• progression to a later stage of disease 
• painful, disease-related overgrowth of lymph nodes or spleen 
• an increase in the rate of lymphocyte production 

Typical treatment approach 

CLL  is probably incurable by present treatments. The primary chemotherapeutic plan is combination chemotherapy with chlorambucil or cyclophosphamide, plus a corticosteroid such as prednisone or prednisolone. The use of a corticosteroid has  the additional benefit of suppressing some related autoimmune diseases, such as immunohemolytic anemia or immune-mediated thrombocytopenia. In resistant cases, single-agent treatments with nucleoside drugs such as fludarabine, pentostatin, or cladribine may be successful. Younger  patients may consider allogeneic or autologous bone marrow transplantation. 

Acute myelogenous leukemia (AML) 

Further information: Acute myeloid leukemia#Treatment 

Many different anti-cancer drugs are effective  for the treatment  of AML. Treatments vary somewhat according  to the age of the patient  and according to  the specific subtype  of AML. Overall, the strategy is to control  bone marrow and systemic (whole-body) disease, while offering specific treatment  for the central nervous system (CNS), if involved. 

In general, most oncologists rely on combinations of drugs for the initial, induction phase of chemotherapy. Such combination chemotherapy  usually offers the benefits of early remission and a lower risk of disease resistance. Consolidation and maintenance treatments are intended  to prevent disease recurrence. 

Consolidation treatment often entails a repetition of induction  chemotherapy or the intensification chemotherapy with additional drugs. By contrast, maintenance treatment involves drug doses that are lower than those administered during the induction phase. 

Chronic myelogenous leukemia (CML) 

Further information: Chronic myelogenous leukemia#Treatment 

There are many possible treatments for CML, but  the standard  of care for newly diagnosed patients is imatinib (Gleevec) therapy. Compared to most anti-cancer drugs, it has relatively few side effects and can be taken orally at home. With this drug, more than 90% of patients will be able to keep  the disease  in check for at least five years, so that CML becomes a chronic, manageable condition. 

In a more advanced, uncontrolled state, when  the patient cannot tolerate imatinib,  or if  the patient wishes to attempt a permanent cure, then an allogeneic bone marrow transplantation may  be performed. This procedure involves high-dose chemotherapy  and radiation followed by infusion  of bone marrow from a compatible donor. Approximately 30% of patients die from this procedure. 

Hairy cell leukemia (HCL) 

Further information: Hairy cell leukemia#Treatment 

Decisions to treat 

Patients with hairy cell leukemia who are symptom-free typically do not receive immediate treatment. Treatment  is generally considered necessary when the patient shows signs and symptoms such as low blood cell counts (e.g., infection-fighting neutrophil count below 1.0 K/µL), frequent infections, unexplained bruises, anemia,  or fatigue that is significant enough to disrupt  the patient's everyday life. 

Typical treatment approach 

Patients who need treatment usually receive either one week of cladribine, given daily by intravenous infusion or a simple  injection under the skin, or six months of pentostatin, given every four weeks by intravenous infusion. In most cases, one round of treatment will produce a prolonged remission. 

Other treatments include rituximab infusion or self-injection with Interferon-alpha. In limited cases, the patient may benefit from splenectomy (removal of the spleen).  These treatments  are not typically given as  the first treatment because their success rates  are lower than cladribine or pentostatin. 

T-cell prolymphocytic leukemia (T-PLL) 

Further information: T-cell prolymphocytic leukemia#Treatment 

Most patients with T-cell prolymphocytic leukemia, a rare and aggressive leukemia with a median survival  of less than one year, require immediate treatment. 
T-cell prolymphocytic leukemia is difficult to treat, and it does not respond to most available chemotherapeutic drugs. Many different treatments  have been attempted, with limited success in certain patients: purine analogues (pentostatin, fludarabine, cladribine), chlorambucil, and various forms  of combination chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone CHOP, cyclophosphamide, vincristine, prednisone COP, vincristine, doxorubicin, prednisone, etoposide, cyclophosphamide, bleomycin VAPEC-B). Alemtuzumab (Campath), a monoclonal antibody that attacks white  blood cells, has been used in treatment with greater success than previous options. 

Some patients who successfully respond to treatment also undergo stem cell transplantation to consolidate the response.