Leukemia Treatment Approaches
Patients with diagnosed leukemia are cared for at City of Hope by a multidisciplinary team of professionals, including hematologists, oncologists, pathologists, specially trained transplant physicians, radiation oncologists, nurses, supportive care specialists, dieticians, therapists, social workers, psychiatrists, psychologists and pharmacists. Each member of the team focuses on individual treatment plans designed to extend life, as well as supportive care to improve the quality of life for patients and their families during the treatment period.

Because our program offers both transplant and non-transplant therapies, there is a smoother transition and expedited treatment for patients who ultimately require a stem cell transplant.

At City of Hope, patients are provided treatments based on the latest evidence and clinical guidelines. Factors that determine the therapy regimen include:

  • Type of leukemia
  • Stage of leukemia
  • Prior therapies, if any
  • Patient’s characteristics, such as age and overall health
  • Choice of the patient and care provider, if multiple treatment options are available

Based on these factors, the leukemia treatment regimen may include one or more of the following:

  • Chemotherapy
  • Immunotherapy
  • Stem cell transplantation
  • Radiation therapy
  • Surgery
  • Supportive Care

Due to the aggressive nature of acute leukemias, ALL or AML patients will usually require hospitalization and more intensive treatments. Those with slower-progressing CML or CLL may be treated in an outpatient setting.

In addition to standard therapies, clinicians and scientists at our Gehr Family Center for Leukemia Research are constantly developing new treatments that may be more effective against leukemia with fewer side effects for the patient.

Chemotherapy

Chemotherapy, or the use of cancer-fighting drugs, is often the main treatment for all forms of leukemia. Because leukemia is a cancer of the blood, surgery is usually not an option as it is with solid tumors. As a result, chemotherapy uses powerful drugs to kill leukemic cancerous cells in the bone marrow and throughout the bloodstream. Chemotherapy is usually given in cycles, with breaks in between to allow patients to recover from side effects.

Standard chemotherapy drugs used for leukemia may include one or more of the following:
 
  • Cytarabine, also known as cytosine arabinoside or ara-C (Cytosar®)
  • Dasatinib
  • Daunorubicin, also known as daunomycin (Cerubidine®) or idarubicin (Idamycin®)
  • Imatinib (Gleevec®)
  • L-asparaginase (Elspar®) or PEG-L-as
  • paraginase (Oncaspar®)
  • Nilotinib
  • Prednisone
  • Vincristine (Oncovin®)
 
Additionally, City of Hope researchers and clinicians are constantly developing new regimens to improve the effectiveness of existing drugs or building new drugs that are more powerful against leukemia. In particular, City of Hope’s leukemia researchers and clinicians are studying ways to target and kill leukemia stem cells, rather than just the mature leukemia cells that are targeted by conventional therapy. By eliminating these “cancer stem cells”, leukemia can be curable by destroying the disease at its source.
 

Immunotherapy

By modifying the immune system, the patient’s own disease-fighting cells can be used to track and attack leukemia cells throughout the body. This can dramatically enhance other leukemia therapies and lead to better outcomes.
 
Immunotherapy approaches being used or studied at City of Hope include:
 
Radioimmunotherapy
 
City of Hope has developed novel ways of delivering radiation utilizing monoclonal antibodies that have been combined with small amounts of radioactive substances. These radio-labeled antibodies allow doctors to target leukemia cells directly while minimizing damage to normal tissues.
 
City of Hope was one of the first programs to use radioimmunotherapy as part of a transplant regimen to improve the safety and effectiveness of the treatment.
 
Adoptive T-Cell Therapy
 
T-cells are a powerful part of the immune system, and a new approach being studied at City of Hope involves redirecting T-cells to recognize cancer cells specific to leukemia. T-cells are extracted and then genetically modified so they can recognize, target and destroy the cancer cells. Studies are ongoing for this novel approach for a number of leukemias, particularly ones that are recurrent, relapsed or refractory.
 

Stem Cell Transplantation

City of Hope is a leader in the use of stem cell transplantation to treat leukemia and other blood cancers. Since the program began in 1976, more than 12,000 transplants have been performed. City of Hope has been recognized for superior survival outcomes for nine consecutive years—the only transplant center in the United States with such an achievement. Our transplant program is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT), the standard of excellence for blood and bone marrow transplant programs in the United States.
 
Transplants are sometimes performed early in the course of treatment to improve long-term results or it may be utilized when other treatments are not working.
In this procedure, a patient undergoes intensive chemotherapy, and sometimes radiation therapy, to destroy the cancer-causing cells followed by an infusion of healthy new stem cells. The stem cell transplant may be either autologous (extracted from the patient’s own body) or allogeneic (using stem cells taken from another person.)

One known complication of allogeneic transplants is graft versus host disease (GvHD), in which the newly transplanted cells does not recognize the recipient’s body as their own and forms an immune response against it. City of Hope is on the forefront of tackling this side effect and is constantly improving allogeneic transplant protocols to reduce GvHD risk and minimizing its impact if it does occur.
 
Nonmyeloablative (Mini) Transplants
 
City of Hope physicians also specialize in “mini” stem cell transplants for patients who cannot tolerate the side effects associated with a standard stem cell transplantation. These transplants rely less on the heavy doses of chemotherapy and radiation and more on the antitumor effects of the graft itself. This novel approachallows patients who are otherwise ineligible, including patients in their 70s, to be treated with this lifesaving procedure. Thus, this is particularly beneficial for CLL patients, who are usually in this age range upon diagnosis.
 

Radiation Therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. City of Hope is the first in the western United States to treat leukemia using the Helical TomoTherapy System®, which reduces the unwanted exposure of normal tissues and reduces potential complications. The system combines radiation delivery with real-time imaging, allowing doctors to deliver a higher dose of radiation with greater precision. This significantly improves outcomes and reduces side effects compared to traditional whole-body irradiation, which unnecessarily exposes healthy tissues to radiation.

Surgery

Because leukemia spreads throughout the bone marrow and bloodstream, surgery plays a limited role in treatment.  However, surgery may be needed to treat localized, leukemia-related conditions.

How to Become a Patient

If you have been diagnosed with leukemia or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.