Treatment of leukaemia varies considerably depending on the types and stages of the leukaemia.
Acute myeloid and lymphoblastic leukaemia
With acute leukaemia, doctor will usually begin treatment right away with repeated cycles of chemotherapy. The initial course of chemotherapy (induction chemotherapy) is very intense and is carried out in hospital. The drugs used and treatment plan are different between AML and ALL. The goal of induction chemotherapy is to eradicate the leukaemia cells in bone marrow and bring the disease in remission. The remission rate for AML is about 50% -70% in adults. In ALL, the remission rate for children is more than 95% and about 75%-89% in adults. All-trans retinoic acid (ATRA), an oral medication, will be used together with chemotherapy if patient has the special subtype of AML called acute promyelocytic leukaemia. During the course of treatment, patients will also receive blood transfusion and other supportive treatment to minimize risks of serious complications such as major bleeding and life-threatening infections.
Once remission is achieved, patient will receive further courses of chemotherapy (consolidation chemotherapy) because acute leukaemia as risk of relapse. Patient with ALL will also receive radiation therapy to the brain and longer period of low-dose oral chemotherapy (maintenance chemotherapy). Doctor may consider stem cell transplantation early in the course of treatment for patient who has high risk disease and matched donors.
Chronic myeloid leukaemia
Treatment options for CML include imatinib (or its alternatives: dasatinib, nilotinib), interferon, hydroxyurea, and allogeneic stem cell transplantation. For most CML patients, imatinib is the standard first line treatment. It stops leukaemic cell production by blocking a specific enzyme called tyrosine kinase in the marrow cell and prevent the development of accelerated phase and blast phase. Most CML patients respond well to imatinib therapy with minimal side effects. Patients who responded to therapy are required to continue the drug indefinitely and are able to continue a normal life. Because of the favorable treatment results of imatinib, imatinib has largely replaced the use of interferon and other therapy. The need for allogeneic stem cell transplantation has also substantially reduced nowadays.
Chronic lymphocytic leukaemia
CLL is generally a slowly growing disease. It usually occurs in older patients. Treatment therefore depends on age of the patient, presence of symptoms, disease stage and general health of the patient.
Most patients, particularly those with early stage disease, are asymptomatic at diagnosis and do not need therapy. Doctor may recommend observation (watchful waiting) initially by regular check-up to carefully monitor patient’s health and disease progress. Treatment usually starts when the disease has progressed or begins to have troublesome symptoms. At this stage, treatment can be chemotherapy or use of monoclonal antibody. Patient may also require blood transfusion or supportive treatment for complications such as infection or anaemia.