Treatment
of Leukemia
Certain features of a leukemia, such as age and initial
white blood cell count, are used in determining the intensity of
treatment needed to achieve the best chance for cure. Although all
children with ALL are treated with chemotherapy, the dosages and drug
combinations may differ.
To decrease the chance that leukemia will invade the central
nervous system, patients receive intrathecal chemotherapy, the
administration of cancer-killing drugs into the cerebrospinal fluid
around the brain and spinal cord. Radiation treatments, which use
high-energy rays to shrink tumors and keep cancer cells from growing,
may be used in addition to intrathecal chemotherapy for certain
high-risk patients. then require continued close monitoring by
a pediatric oncologist, a specialist in childhood cancer.
After treatment begins, the goal is remission of
the leukemia (when there is no longer evidence of cancer cells in the
body). Once remission has occurred, maintenance chemotherapy is usually
used to keep the child in remission. Maintenance chemotherapy is given
in cycles over a period of 2 to 3 years to keep the cancer from
reoccurring. Leukemia will almost always relapse (reoccur) if this
additional chemotherapy isn't given. Sometimes the cancer will return
in spite of maintenance chemotherapy, and other forms of chemotherapy
will then be necessary.
Sometimes a bone marrow transplant may be necessary in addition to -
or instead of - chemotherapy, depending on the type of leukemia a child
has. During a bone marrow transplant, healthy bone marrow is introduced
into body.
Intensive leukemia chemotherapy have certain side effects, including
hair loss, nausea and vomiting in the short term, and potential health
problems down the line. As treated for leukemia, cancer treatment team will monitor the child closely for those
side effects.
But with the proper treatment, the outlook for kids who are
diagnosed with leukemia is quite good. Some forms of childhood leukemia
have a remission rate of up to 90%; all children then require regular
maintenance chemotherapy and other treatment to continue to be
cancer-free. Overall cure rates differ depending on the specific
features of a child's disease. Most childhood leukemias have very high
remission rates. And the majority of children can be cured - meaning
that they are in permanent remission - of the disease.
Blood
Transfusion
Each year, more than15 million units of
whole blood are collected and nearly five million patients are
transfused with blood components in the United States. (Source: The
National Blood Data Resource Center 2001, the most recent year for
which data are available.) On average, each unit is divided into three
different components: red cells, platelets and plasma. Most of the red
cells are transfused to patients undergoing surgical procedures.
However, patients with blood cancers frequently receive platelets and
some red cells. They may require more blood components overall than
surgical patients because their need is likely to continue over a
number of weeks or longer. In addition, most patients who undergo
marrow or blood stem cell transplantation will be transfused.
Immunothrapy
Immunotherapies are relatively new and
promising treatment options for patients with blood cancers. Their
development is based on the concept that immune cells or their
products, such as antibodies, can be engineered to recognize and kill
cancer cells. Monoclonal antibody therapy, donor lymphocyte infusion,
vaccine therapy and immune cell-stimulating cytokine therapy are types
of immunotherapies that are in use or under study to determine their
effectiveness in fighting cancers. Researchers think that
immunotherapies could be less toxic to patients than chemotherapy or
radiotherapy. Radiation therapy and most chemotherapy works by damaging
the DNA of cancer cells. These therapies generally damage the DNA in
normal cells also. This can lead to toxicity or side effects for the
patient. One of the challenges for researchers in
developing new and better treatments is to learn more about the
differences between cancer cells and normal cells. Cancer cells appear
to be composed almost entirely of the same structures as normal cells.
Any difference in structure that can be identified as unique to the
cancer cell will help researchers to develop treatments that destroy
cancer cells but spare normal cells. Another approach that is
being explored by researchers is to find cancer cell structures that
are shared only by normal cells of the same type. For example, one
current immunotherapy agent, rituximab (Rituxan®), is an
approved treatment for B cell lymphoma. The therapy targets lymphoma
cells by recognizing a protein on the surface of the lymphoma cell.
Rituxan® has a temporary toxic effect on normal B cells because they carry the same target protein.
However, potentially more serious and longer-lasting toxicities to
other normal tissue, such as marrow, lung, liver, heart, and kidney are
avoided. Immunotherapy is likely to be used in combination with,
or following, chemotherapy. It is less likely to be used as a single
agent for treating established blood cancers. However, immunotherapies
may be effective in keeping residual malignant cells in check for
prolonged periods in patients treated previously, or simultaneously,
with chemotherapy or radiation therapy.
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