Methods of treatment of acute leukemia in adults
Acute leukemia in adults - is not a single disease but a few, and patients with different subtypes of leukemia respond differently to treatment.
The choice of therapy is based on a specificsubtype of leukemia, as well as on certain characteristics of the disease, known as prognostic signs. These signs include: patient's age, the number of white blood cells, the response to chemotherapy, and information about whether it was treated before the patient about other tumors.
Under chemotherapy refers to the use ofdrugs that destroy cancer cells. Typically anticancer drugs administered intravenously or orally (through the mouth). Once the drug enters the bloodstream, it spreads throughout the body. Chemotherapy - the main method of treatment of acute leukemia.
Chemotherapy of acute lymphoblastic leukemia (ALL)
Induction. The aim of treatment at this stage is - the destruction of the maximum number of leukemia cells in a minimum time period and remission (no evidence of disease).
Consolidation. The objective at this stage of treatment is to destroy the tumor cells that remained after the first etipa - induction.
Supportive therapy. After the first two stages of chemotherapy in the body may still be leukemia cells. At this stage of treatment prescribed low doses of chemotherapy for two years.
Treatment of central nervous system(CNS). Due to the fact that acute lymphoblastic leukemia often spreads to the brain and spinal cord, patients are administered chemotherapy drugs into the spinal canal or radiation therapy to the brain.
Chemotherapy of acute myeloid leukemia (AML)
Treatment of AML consists of two phases: induction of remission and treatment after remission.
During the first phase is destroyed mostnormal and leukemic bone marrow cells. The duration of this phase - usually one week. During this period and in the next few weeks the number of white blood cells is very low and therefore require measures against the possible complications. If the weekly chemotherapy remission is reached, there shall be repeated courses of treatment.
The aim of the second phase - the destruction of the remainingleukemia cells. Treatment for a week and then followed by a period of bone marrow recovery (2-3 weeks), followed by chemotherapy courses last a few more times.
Some patients receive chemotherapy very high doses of drugs to kill all bone marrow cells, and then performed the transplantation of stem cells.
Side effects of chemotherapy
In the process of the destruction of damaged cells and normal cells of leukemia cells, which along with the tumor cells also exhibit rapid growth ..
Bone marrow cells mucosamouth and intestine, hair follicles and their rapid growth and therefore exposed to chemotherapy. Therefore, patients receiving chemotherapy have an increased risk of infection (due to low white blood cell count), bleeding (low platelet count) and fatigue (low red blood cell count). Other side effects of chemotherapy include: temporary hair loss, nausea, vomiting and loss of appetite.
These side effects usually disappear soon afterchemotherapy discontinuation. Typically, there are methods of dealing with side effects. For example, for the prevention of nausea and vomiting with chemotherapy appointed antiemetics. To increase the number of leukocytes and preventing infection of cell growth factors are used.
You can reduce the risk of infectious complicationsby limiting the exposure to microbes by thorough hand washing, eating specially prepared fruit and vegetables. Patients receiving the treatment should avoid crowds and sick with an infection.
During chemotherapy, patients can be assignedstrong antibiotics for the prevention of further infection. Antibiotics may be applied at the first sign of infection or even earlier in order to prevent infection. By reducing the number of platelet transfusions may they, as well as reducing the transfusion of red blood cells in and occurrence of shortness of breath or fatigue.
tumor lysis syndrome - a side effect,caused by the rapid collapse of the leukemic cells. When the death of tumor cells into the bloodstream, they release substances which damage the kidneys, heart and CNS. Appointment of the patient plenty of fluids, and special drugs to help prevent the development of serious complications.
In some patients with ALL after treatment later may have other types of malignant tumors: AML, non-Hodgkin's lymphoma (lymphosarcoma), or others.
Stem cell transplantation (SCT)
Chemotherapy damages both tumor andnormal cells. Transplantation of stem cells allows doctors to use higher doses of anticancer drugs to improve the treatment efficacy. Although the antineoplastic agents destroy the patient's bone marrow transplanted stem cells help restore bone marrow cells that produce blood cells.
Stem cells are collected from bone marrow orfrom peripheral blood. These cells are obtained from both the patient and from a matched donor. In patients with leukemia donor cells are most commonly used as a bone marrow or peripheral blood of patients are tumor cells.
Patients received chemotherapy is very highdoses of drugs to kill tumor cells. In addition to the radiation therapy to kill remaining leukemia cells. After this treatment the stored stem cells are administered to the patient in the form of a blood transfusion. Gradually prizhivlyayutsya transplanted stem cells in the bone marrow of the patient and begin to produce blood cells.
Patients who were transplanted donor cells,appointed agents to prevent rejection of the cells, as well as other drugs to prevent infections. 2-3 weeks after the stem cell transplantation, they begin to produce white blood cells, then platelets, and finally - erythrocytes.
Patients who underwent SCT shouldprotected against infection (to be isolated) to the required increase in the number of white blood cells. Such patients are in the hospital until the number of leukocytes in about 1000 cc. Blood mm. Then, almost every day, such patients are observed in the clinic for several weeks.
Stem cell transplantation is still new and complex treatment. Therefore, this procedure should be carried out in specialized units with specially trained personnel.
Side effects associated with stem cell transplantation
Side effects of ECT are divided into early andlater. Early side effects are not very different from events in patients receiving chemotherapy with high doses of anticancer drugs. They are caused by damage to the bone marrow and other rapidly growing tissues of the body.
Side effects may exist for a long time, sometimes years after undergoing a transplant. Of late side effects should note the following:
- Radiation damage to the lungs, leading to shortness of breath;
- The reaction of "graft versus host disease" (GVHD)which only occurs during transplantation of cells from a donor. This serious complication occurs when the donor's immune cells attack the skin, liver, oral mucosa and other organs of the patient. At the same time there are: weakness, fatigue, dry mouth, rash, infection and muscle pain;
- Damage to the ovaries leading to infertility and menstrual irregularities;
- Damage to the thyroid gland, causing a metabolic disorder;
- Cataract (eye lens damage);
- Damage to the bone; in severe changes may require the replacement of part of the bone or joint.
Radiation therapy (using high-energy X-rays) plays a limited role in the treatment of leukemia patients.
In adult patients with acute leukemia exposureIt can be applied in lesions of the CNS or the testes. In rare cases of emergency radiation therapy is indicated for relief of compression of the trachea cancer. But even in this case, it is often used instead of radiation therapy chemotherapy.
In the treatment of patients with leukemia, unlike the othertypes of cancers, surgery is usually not used. Leukemia - disease of the blood and bone marrow, and it can not be cured surgically.
In the treatment of leukemia patients usingsmall surgical intervention may be introduced a catheter into a large vein for administration of anticancer and other drugs, taking blood for research.
What happens after the treatment of acute leukemia
After completion of treatment for acuteleukemia must be dynamic observation in the clinic. This observation is very important, as it allows the doctor to watch for possible recurrence (return) of the disease, as well as side effects of therapy. It is important to immediately inform your doctor about symptoms appear.
Typically, a relapse of acute leukemia if it happens, occurs during treatment or shortly thereafter. Relapse is developing very rarely after remission, the duration of which exceeds five years.