Treatment for acute forms of adult leukemia has advanced markedly since the days when all patients generally received the same course of treatment. A patient’s age and overall health, the type of leukemia he or she has, and the goal of therapy all influence the treatment plan.
What are the types of acute leukemia?
There are two major forms of acute leukemia:
- Acute lymphoblastic leukemia (ALL), which begins in cells that become white blood cells known as lymphocytes
- Acute myeloid leukemia (AML), which starts in early myeloid cells that become white blood cells other than lymphocytes and is the most common type of leukemia in adults.
Both are termed “acute” because they grow rapidly.
What are the main treatment approaches for acute leukemia?
Treatment usually follows one of the following courses:
- Patients with AML who are under the age of 75 and have no other major illnesses (particularly heart, lung, or kidney disease) tend to be treated with high-dose chemotherapy until their blood counts recover. This can entail hospital stays averaging four to six weeks. After discharge from the hospital, they receive a few more rounds of “consolidation” chemotherapy, which can be done on an outpatient basis. Approximately 80% may eventually undergo a stem cell transplant.
- Patients with AML who are over the age of 75 or have multiple medical illnesses generally receive a shorter course of lower-dose chemotherapy, which can require about five days in the hospital. This is followed by a period of intensive outpatient monitoring, which may consist of twice-weekly clinic visits for blood transfusions and platelet transfusions. These patients then continue cycles of chemotherapy every four weeks. Patients who go into remission may continue receiving chemotherapy but often don’t require additional transfusions.
- For patients with ALL, treatment is again divided by age and medical conditions. For older patients, a less intense chemotherapy is used to gain control of the disease, although this treatment is not curative. It initially requires weekly visits for chemotherapy and periodic blood and platelet transfusions.
- For younger patients with ALL, the initial therapy is a series of cycles of high-dose chemotherapy. This often requires a three- to four-week hospital stay initially, followed by intensive outpatient therapy. Most patients will require a bone marrow transplant, which is performed with a goal of cure, but younger patients can often be cured with chemotherapy alone, which requires a total two-year treatment course.
The more individualized approach to treatment, particularly in AML, is a signal improvement over the old one-size-fits-all model. This trend has accelerated as researchers have identified genetic mutations in leukemia cells that can be targeted with specific drugs.
Older patients with acute leukemia who aren’t able to tolerate high-dose chemotherapy, for example, often benefit from the drug venetoclax, whose development grew out of research by Dana-Farber scientists. Institute researchers are now leading clinical trials of the drug in combination with other agents in younger patients.
Staying safe during the COVID-19 pandemic
Care teams at Dana-Farber want leukemia patients, and all patients with cancer, to take precautions during the pandemic. Both younger and older patients need to be extremely cautious about avoiding possible sources of infection even after their blood counts have recovered following treatment.
“Our biggest concern in getting patients who have been treated for leukemia back to normalcy is preventing infection,” says Eric S. Winer, MD, clinical director of the Adult Leukemia Program at Dana-Farber. “The precautions we ask patients to take are in many ways similar to the recommendations for everyone during the COVID-19 pandemic: wearing a mask, maintaining a safe distance from other people, disinfecting surfaces, washing hands, etc.”