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There are many types of Cancer Treatment. The types of treatment that you have will depend on the type of cancer you have and how advanced it is. Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. You may also have immuno-therapy, targeted therapy, or hormone therapy.

Leukemia Treatment

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Leukemia

Leukemia has essentially 4 subtypes;

CML - Chronic Myeloid Leukemia

With modern treatments, it’s often possible to control Chronic Myeloid Leukemia (CML) for many years. In a small number of cases, it may be possible to cure it completely.

Imatinib:

Imatinib is the primary treatment for CML, typically administered promptly after diagnosis to impede cancer progression and prevent it from advancing to a severe stage. This medication reduces the production of abnormal white blood cells and is taken as a daily tablet. The mild side effects, such as nausea, swelling, muscle cramps, rash, and diarrhea, generally improve over time. Regular blood tests and occasional bone marrow tests assess the treatment’s effectiveness, and if successful, imatinib is usually taken lifelong.

Nilotinib:

In cases where imatinib is unsuitable or ineffective, nilotinib may be recommended. Nilotinib, similar to imatinib, is taken as a capsule twice a day. Common side effects include headaches, nausea, abdominal pain, rash, itching, hair loss, muscle pain, and fatigue. Temporary treatment cessation can alleviate troublesome side effects, and if the medication proves effective through blood and bone marrow tests, it is often taken lifelong.

Dasatinib:

If imatinib or nilotinib is not viable or ineffective, dasatinib, a comparable medication, may be suggested. Taken once daily as a tablet, dasatinib may be continued for life based on blood and bone marrow test results. Side effects encompass an increased infection risk, fatigue, shortness of breath, diarrhea, headaches, and rash.

Bosutinib:

For those unable to take or respond to imatinib, nilotinib, or dasatinib, bosutinib may be recommended. This daily tablet, taken for life if effective according to tests, may induce side effects such as diarrhea, nausea, abdominal pain, fever, and rash.

Ponatinib:

Specifically for individuals with the T315I mutation, ponatinib is a daily tablet taken for life if tests indicate effectiveness. Side effects include an elevated infection risk, tiredness, shortness of breath, headaches, rash, and joint pain.

Combination Therapy:

In certain instances, a combination of these medications might be advised, tailored to individual responses. High-dose imatinib, dasatinib, and nilotinib could be combined for those unresponsive to normal-dose imatinib.

Chemotherapy:

Chemotherapy may be recommended if other medications are unsuitable or if CML advances. Tablets are typically preferred due to milder side effects, including fatigue and rash. Injections may be considered if symptoms persist, accompanied by more severe effects like nausea, hair loss, and infertility.

Stem Cell or Bone Marrow Transplants:

Reserved for potential cure, transplants involve high-dose chemotherapy and radiotherapy to eradicate cancerous cells. Stem cells from a closely related donor are transplanted, but this intensive treatment is only suitable for certain individuals, often younger patients in good health with a compatible sibling donor.

It’s important to note that, with advancements like imatinib, stem cell transplants are considered in select cases due to potential risks outweighing benefits, particularly with effective long-term control achievable through medication.

AML - Acute Myeloid Leukemia

Acute Myeloid Leukemia (AML) is an aggressive cancer that grows quickly, so treatment will usually begin a few days after a diagnosis has been confirmed.
As AML is a complex condition, a team of various specialists, known as a multidisciplinary team (MDT), usually collaborates to provide treatment.

Your Treatment Plan:

Treatment for AML typically consists of two stages:

– Induction: This initial stage focuses on eliminating as many leukemia cells in the blood and bone marrow as possible and addressing any associated symptoms.

– Consolidation: Following induction, this stage aims to prevent cancer recurrence by eradicating any remaining leukemia cells in the body.

The success of the induction stage can vary, and it may need to be repeated before consolidation begins. For individuals at high risk of complications, such as those over 75 or with underlying health conditions, less intensive chemotherapy may be considered.

Induction:

The choice of initial AML treatment depends on whether the individual can tolerate intensive chemotherapy or requires a lower-dose treatment.

Intensive Chemotherapy: This involves administering high doses of chemotherapy drugs to kill cancerous cells in the blood and bone marrow. Usually, a combination of two or more chemotherapy drugs is used over two rounds. Treatment is conducted in a hospital or specialized center with close medical supervision. Regular blood transfusions are necessary due to reduced healthy blood cells, and precautions are taken to prevent infections. Side effects are common and include nausea, bleeding, diarrhea, loss of appetite, mouth sores, fatigue, skin rashes, hair loss, and potential infertility.

Non-intensive Chemotherapy: If intensive chemotherapy is deemed unsuitable, an alternative, less intense form of chemotherapy may be recommended. This can be administered through a vein, orally, or by injection under the skin, often on an outpatient basis.

Other Drugs: Individuals with acute promyelocytic leukemia may receive additional drugs alongside chemotherapy, such as all-trans retinoic acid (ATRA) and arsenic trioxide, each with its set of side effects.

Consolidation:

Following successful induction chemotherapy, consolidation treatment involves regular injections of chemotherapy medication, usually administered in a hospital, lasting several months.

Other Treatments:

– Radiotherapy: High-dose radiation may be used to prepare for a bone marrow or stem cell transplant or to treat advanced cases that have spread to the nervous system or brain. Side effects include hair loss, nausea, and fatigue.

– Bone Marrow and Stem Cell Transplants: If chemotherapy is ineffective, a transplant may be considered. Before the transplant, the recipient undergoes intensive chemotherapy and possibly radiotherapy to clear bone marrow cells. Donated stem cells are then infused through a blood vessel. Transplant recipients may need to stay in isolation for weeks due to infection risk. Better outcomes are expected if the donor has the same tissue type, typically a sibling.

CLL - Chronic Lymphocytic Leukemia

Treatment for Chronic Lymphocytic Leukemia (CLL) largely depends how far developed it is when it’s diagnosed.

If detected early, monitoring may be sufficient initially, while more advanced cases of Chronic Lymphocytic Leukemia (CLL) often require chemotherapy as the primary treatment. CLL can be effectively controlled for many years with appropriate treatment. The condition may enter remission after the initial treatment, but relapse is common, necessitating additional treatment.

Stages of CLL:

Doctors categorize CLL into three main stages to assess its development and determine the need for treatment:

Stage A: Enlarged lymph glands in fewer than three areas, accompanied by a high white blood cell count.

Stage B: Enlarged lymph glands in three or more areas and a high white blood cell count.

Stage C: Enlarged lymph glands or spleen, high white blood cell count, and low red blood cell or platelet count.

Treatment is typically initiated promptly for Stage B and C CLL, while Stage A may only be treated if it worsens rapidly or starts causing symptoms.

Monitoring Early-Stage CLL:

If diagnosed with CLL without symptoms, treatment may not be necessary due to the slow development of the condition. Regular doctor visits and blood tests are often sufficient for monitoring. Chemotherapy is usually recommended only if symptoms appear or the condition worsens based on test results.

Chemotherapy for More Advanced CLL:

For CLL management, chemotherapy is often necessary, involving a combination of three medicines administered in 28-day treatment cycles. Common medications include fludarabine, cyclophosphamide, and rituximab. While the first two are usually taken at home, rituximab is given intravenously in a hospital setting. Alternative medications may be considered based on individual suitability.

Side Effects of Treatment:

Significant side effects of CLL treatment include persistent tiredness, nausea, infection risk, bruising, anemia, hair loss, irregular heartbeat, and allergic reactions. Most side effects resolve after treatment cessation.

Stem Cell or Bone Marrow Transplants:

Stem cell or bone marrow transplants aim to eliminate CLL entirely or prolong control. The procedure involves high-dose chemotherapy and radiotherapy to eradicate cancerous cells, followed by transplanting donor stem cells. While this is a potential cure, its intensive nature and associated risks limit its application, especially in older individuals.

Other Treatments for CLL:

Various treatments address complications or offer alternatives to chemotherapy:

  • Radiotherapy shrinks enlarged lymph glands or a swollen spleen.
  • Surgery may remove a swollen spleen.
  • Antibiotics, antifungals, and antiviral medicines reduce infection risk.
  • Blood transfusions provide additional red blood cells and platelets.
  • Immunoglobulin replacement therapy prevents infections.
  • Granulocyte-colony stimulating factor (G-CSF) injections boost white blood cell count.

Additional treatments may be required for CLL complications that arise.

ALL - Acute Lymphoblastic Leukemia

Acute Lymphoblastic Leukemia develops quickly, so treatment usually begins a few days after diagnosis.

Stages of treatment

Treatment for acute lymphoblastic leukemia typically involves three stages:

1- Remission Induction:

– The initial stage aims to eliminate leukemia cells in the bone marrow, restore blood cell balance, and alleviate symptoms.

– Administered in a hospital or specialized center, requiring regular blood transfusions due to insufficient healthy blood cells.

– Vulnerability to infections necessitates a sterile environment, with antibiotics given for infection prevention.

– Methotrexate, a chemotherapy medicine, is used, with injections administered via a central line or into cerebrospinal fluid to target nervous system cells.

– Common chemotherapy side effects include nausea, diarrhea, fatigue, mouth ulcers, infertility, and hair loss.

2- Consolidation

– The goal is to eliminate any remaining leukemia cells through regular outpatient injections of chemotherapy medicine.

– Short hospital stays may be necessary for symptom exacerbation or infections during the consolidation phase, which spans several months.

3- Maintenance:

– Ensures leukemia does not return by administering regular chemotherapy doses and monitoring through check-ups.

– Typically extends for about two years.

Other Treatments:

Steroid Therapy: Injections or tablets may complement chemotherapy to enhance effectiveness.

Targeted Therapies: For Philadelphia chromosome-positive acute lymphoblastic leukemia, imatinib is employed, blocking signals causing cancerous cell growth.

Alternative Targeted Therapies: Dasatinib and ponatinib may be considered if the initial treatment is ineffective or in specific leukemia types.

Additional Treatments:

Radiotherapy: High-dose radiation targets cancerous cells, particularly when leukemia has spread to the nervous system or brain or to prepare for a bone marrow transplant. Side effects include hair loss, nausea, and fatigue.

Stem Cell and Bone Marrow Transplants: An option if chemotherapy proves inadequate. Ideal donors, usually siblings, enhance transplant success. Recent research suggests reduced-intensity transplants for individuals over 40.

Immunotherapy: Medicines like blinatumomab, inotuzumab, and ozogamicin stimulate the immune system to target and eliminate cancer cells. Administered through a vein drip, immunotherapy may cause flu-like symptoms, dizziness, bleeding, nausea, and increased susceptibility to infection.

Understanding the stages and varied treatments for acute lymphoblastic leukemia facilitates comprehensive care and management.

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