Treatment of leukemia – basic methods and regimens
A person with leukemia, the bone marrow produces large number of abnormal white blood cells, called leukemia cells. These cells grow very quickly and continue to grow, in contrast to healthy cells.
If you do not start early treatment of leukemia, the leukemic cells may eventually completely displace the healthy blood cells. As a result, serious problems such as bleeding, anemia, and various viruses and infections. The leukemic cells have the ability to penetrate the organs and lymph nodes, which in turn causes severe pain and the formation of tumors.
Varieties of leukemia
In General, all cases of leukaemia vary, because what kind of leukocyte affected and the speed of the disease. But first and foremost it is worth noting two forms of leukemia: acute and chronic. Acute leukemia occurs rapidly and the patient's condition deteriorates. Chronic leukemia for a long time can occur without obvious symptoms.
It meets as myeloid and lymphoblastic leukemia. In myeloid leukemia the affected myelocytes, cells which develop white cells. Lymphoblastic leukemia affects the white blood cells themselves. Thus, there are four varieties of the disease:
1. Acute myeloid leukemia (AML);
2. Acute lymphoblastic leukemia (ALL);
3. Chronic myeloid leukemia (CML);
4. Chronic lymphoblastic leukemia (CLL).
The reasons for the development of leukemia
For a long time scientists are trying to find the answer to this question, but so far the reasons for the development of leukemia is not known. But the factors that increase the risk of developing the disease. These include the following:
- The chemotherapy that the patient goes for treatment of other cancers;
- Prolonged exposure to radiation;
- Contact with chemical substances, for example, benzene;
- Some genetic disorders;
However, you need to consider the fact that the impact of these factors increases the likelihood of developing leukemia, but many people with this diagnosis are not at risk.
Leukemia is diagnosed after a routine blood sampling from the patient for analysis. If the result is determined by high levels of white blood cells, biopsy of the bone marrow. Thus confirmed or refuted the hypothesis of the development of leukemia and determines what type of disease the patient has. Only then can you judge whether the leukemia is treated, and prescribe treatment.
The choice of treatment of leukemia
Treatment of leukemia is determined based on many factors. The selected method depends on the type of leukemia, the degree of development of the disease, patient's age and General health. Acute leukemia requires prompt treatment to stop rapid growth of cancer cells. In most cases it is possible to improve the condition of the patient, but the chance that the cancer will come back, remains.
The treatment of leukemia: the basic methods
- Chemotherapy, in which powerful medicines to destroy cancer cells.
- Radiotherapy or radiation therapy. With this method of treatment cancer cells are destroyed using powerful x-rays or other radiation. In some cases, this therapy is used prior to transplantation of stem cells.
- Transplantation of stem cells. Stem cell transplant can help restore production to healthy cells and improve the immune system. Before the transplant, usually radiotherapy or chemotherapy. It is necessary for the destruction of the cells of the bone marrow and make spacefor stem cells. Chemotherapy and radiation x-rays or other radiation as is necessary for the weakened immunity of the patient. Otherwise, it may reject the transplanted cells.
- The use of special drugs. Cell growth can be suppressed and with the help of special drugs, for example cytostatic drugs. Strong immunoregulatory effect and have hormones glucocorticoid group, which also prescribed for the treatment of leukemia.
- A bone marrow transplant. If the disease is started again, the patient is transplanted bone marrow from a donor. Bone marrow cells of the donor to stimulate the activity of the bone marrow of the patient and mainly occurs improving his condition.
Treatment of leukemia does the patient virtually defenseless against infections. Therefore, the patient at the time therapy is completely isolated from any contact. For prevention he prescribed antivirals and antibiotics. If the patient starts bleeding, the transfusion of blood or blood components.
The treatment of leukemia: schematic of cytostatic therapy
Schemes of cytostatic therapy tailored to the features of the cells in different types of the disease. Chemotherapy drugs are divided into two groups:
- Means affecting the life cycle of a cancer cell;
- Substances acting independently of the life cycle of cells;
Different types of leukemia are treated according to established standards of chemotherapy. These standards differ depending on clinical and hematological differences, but, in General, cytostatic therapy is conducted according to the program, the same for all patients.
If conducted cytogenetic study has not helped in the group definition, then the induction of remission is carried out according to the scheme "7+3". The patient is administered idarubicin, daunorubicin or mitoxantrone and cytarabine (100mg/m). If the initial course of therapy have not helped to achieve remission, then after a month prescribe a second course of induction. For greater efficiency of treatment it is advisable to carry out simultaneously the introduction of Neupogen.
If remission is achieved. The result is assigned four courses of Cytosar in high doses.
After induction therapy and consolidation of the patient is administered amifostine (500 mg/in) to restore hematopoiesis. The duration of this treatment – 50 minutes, three times a week to achieve the desired results.
If the tumor clone identified cytogenetic changes, the treatment of leukemia is performed by the following algorithm: four courses of Cytosar (100-1500 mg/m2 three hour infusion twice a day, every 12 hours 1, 3 and 5 day. After that, the chemotherapy is stopped and is observing the patient's condition.
After remission the patients in whom the likelihood of re development of disease is high, it is recommended that bone marrow transplantation from related or alternative donor.
Supportive treatment of leukemia
To keep the results of treatment, it is important to use the right accompanying therapy which includes control of complications, detoxication and transfusion therapy. For the treatment of bacterial infections, use antibiotics of a wide range of action: amikacin, cefepim, teicoplanin, unasyn, ceftazidim. Medication is selected taking into account the sensitivity of microflora to him.
Fungal lesions of the mucous membranes or fungal processes are treated with amphotericin b, fluconazole. For the treatment of viral infections prescribe antiviral drugs, such as valaciclovir, aciclovir, Cymevene.
To eliminate hemorrhagic syndrome use transfusion of platelet concentrate. Andas aminocaproic acid, recombinant activated factor VII (NovoSeven), which is used during heavy bleeding and did. In the development of ice use of fresh frozen plasma and heparin. Substitution therapy is the transfusion of erythrocytes and reduction of hemoglobin.
What's the prognosis in leukemia
Difficult to say, whether the leukemia is treated, but the use of modern programs and proper supportive treatment provides a survival rate without relapse in 20-30% of patients.
Without adequate treatment, the patient with acute leukemia die very quickly, but with proper treatment, the prediction is often favorable, especially for children. AML – 95% of cases of complete remission, the AML – 75%.
Chronic leukemia without treatment leads to death of the patient for several months. But if you draw the right treatment, the patient can live without a remission for many years. But it should be noted that a chronic form of leukemia can go into acute leukemia or blast crisis, is virtually untreatable.