Available treatment for leukemia cancer

Leukemia Treatment Options​

Treatment of leukemia varies with the type (acute or chronic, lymphocytic or myeloid), the age of the patient, general health, and the occurrence of genetic mutations. The following are the primary treatment methods:

Chemotherapy

• Most used treatment, employing drugs to destroy leukemia cells.
• Usually administered in cycles to enable the body to recover between administrations.
• Can involve a combination of drugs.

Targeted Therapy

• Employing drugs that target leukemia cells with genetic mutations.
• Examples are imatinib (Gleevec), dasatinib (Sprycel), and venetoclax (Venclexta) based on the type of leukemia.

Immunotherapy

• Stimulates the immune system to destroy leukemia.
• Comprises monoclonal antibodies (e.g., rituximab, blinatumomab) and CAR T-cell therapy (e.g., tisagenlecleucel for patients with ALL).

Radiation Therapy

• Destroys leukemia cells using high-energy X-rays.
• Used frequently in leukemia that has spread to the brain or for palliation.

Bone Marrow/Stem Cell Transplant

• Replaces unhealthy bone marrow with healthy stem cells.
• Needs high-dose chemotherapy or radiation therapy initially to kill the current bone marrow.
• May be autologous (stem cells donated by the patient) or allogeneic (donor).

Supportive Therapy

• Comprises blood transfusions, antibiotics, and medications for controlling side effects.

Chemotherapy for Leukemia​

• Induction Therapy: The first goal of the treatment was to place the leukemia into a state of relapse. It uses very strong chemotherapy medications, mostly administered through an IV drip.
• Common drugs: Ara C, Daumorubicin, Idarubicin.
• Consolidation Therapy: This is done after remission in order to kill of any leukemia cells that may still be present but are too small to be seen.
• High-dose Chemotherapy: Occasionally given in individuals where there are chances that the client may relapse.

Targeted Therapy for Leukemia​

• This treatment attacks particular changes or proteins on the leukemia cells’ DNA not allowing them to replicate.

Examples of targeted therapies for AML:

• FLT3 inhibitors (e.g., Midostaurin): Used for FLT3-mutated AML.
• IDH inhibitors (e.g., Enasidenib, Ivosidenib): For AML with IDH mutations.
• BCL-2 inhibitors (e.g., Venetoclax): Combined with chemotherapy especially for older patients or those with some accompanying diseases.

Immunotherapy for Leukemia​

• Monoclonal Antibodies: These are man-made antibodies that can well fit on cancer cells and either kill them or give a sign to other parts of immune system to do so.
• CAR-T Cell Therapy: This involves tries to make a patient’s T Cells to be more effective in detecting leukemia. It is still being researched for the treatment of AML.

Bone Marrow Transplant for Leukemia​

• Allogeneic Stem Cell Transplant: This is recommended for patients who are most likely to have a relapse. Those include but are not limited to; Auto-transplantation, in which the individual receives his/her own stem cells, deceased donors, in which stem cells are harvested from a deceased person, matched unrelated donor in which stem cells are taken from a stranger with close HLA match to the patient or family member in which stem cells are taken from a related but non-identical donor.
• Autologous Stem Cell Transplant: This is where the patient’s own stem cells are collected, stored and then modified by other processes to exterminate any existing malignant cells.

Acute Lymphoblastic Leukemia Treatment​

Treatment for Acute Lymphoblastic Leukemia (ALL) varies based on age, leukemia type, gene mutations, and general health. The aim is to kill leukemia cells and stop them from returning. Treatment usually takes three phases: Induction, Consolidation, and Maintenance.

Induction Therapy (First Phase)

Objective: Eradicating most of the leukemia cells and putting into remission.

Duration: 4–6 weeks.

Treatment Includes:

• Chemotherapy: Combination of drugs like vincristine, daunorubicin, corticosteroids (prednisone or dexamethasone), L-asparaginase
• Targeted Therapy: In case of Philadelphia chromosome positive (Ph+ ALL), imatinib (Gleevec) or dasatinib (Sprycel) can be provided.
• CNS Prophylaxis: To avoid the metastasis of leukemia to the CNS, IT Chemotherapy, methotrexate or cytarabine is administered.

Consolidation Therapy (Second Phase)

Objective: To end the disease at its source and prevent the possibility of the leukemia returning.

Duration: A few months.

Treatment Includes:

• High-dose chemotherapy
• Targeted therapy (possible)
• Intrathecal chemotherapy for CNS prophylaxis

Maintenance Therapy (Third Phase)

Objective: Non-Relapse and maintaining Remission with Leukemia

Duration: 2–3 years (longer in children).

Treatment Includes:

• Cytotoxic agents with lesser dose (mercaptopurine, methotrexate, vincristine and steroids).

Acute Myeloid Leukemia Treatment​

Acute Myeloid Leukemia (AML) is a type of aggressive cancer that affects your bone marrow and blood. The treatment for acute myeloid leukemia is usually to eliminate the leukemia cells and to allow the body to produce normal blood cells. 

Chronic Lymphocytic Leukemia Treatment​

Chronic Lymphocytic Leukemia more commonly referred to as CLL is a type of leukemia that takes time to progress and is usually experienced mostly by older adults. The treatment depends on disease phase, presenting symptoms, and genetic aberrations such as TP53, IGHV, or del (17p).

(For Early-Stage CLL)

• In cases where none of such complications or symptoms appears, then the treatment can be deferred.
• A schedule of periodic Health maintenance with a Physician examination and blood tests being done regularly.
• It is given when the symptoms including; weakness, night sweating, swollen lymph nodes, or recurrent infection appear.

Chronic Myeloid Leukemia Treatment​

CML is a slow-growing type of blood cancer that is a result of the Philadelphia chromosome or, more accurately, BCR-ABL1 gene fusion. As for the treatment of leukemia, it is aimed at influencing this mutation to slow down the growth of leukemia cells.

Tyrosine Kinase Inhibitors (TKIs) – First-Line Treatment

All the TKIs inhibit BCR-ABL1 protein by binding to it to halt the growth of leukemia cells. It is administered as pills which are to be taken orally on a daily basis.

Second- and Third-Line TKIs (For Resistant or Relapsed CML)

If the first generation TKIs ceases to be effective due to developed mutations or side effects, the next generation of TKIs may be used:

• Ponatinib (Iclusig) – Used for T315I mutation (a common resistant form).
• Asciminib (Scemblix) – A new TKI for the fourth line and more for patients who have already gone through many treatments.

Stem Cell Transplant (For Advanced or Resistant CML)

This is given for patients who have resistance to TKI or in the blast crisis phase.

• Called allogeneic transplant that needs a matched donor only.
• High risk analysis: It is the game and has the possibility of cure.

Supportive Therapies

• Hydroxyurea – Administered to reduce the white blood cell count in the early stages before the onset of effects of Tyr kinase inhibitors.
• Blood transfusions – anaemia if this occurs.
• The antibiotic & antiviral medication – for infectious diseases or viral infections.

Latest Advancements in Leukemia Treatment​

Currently, there are new methods used to treat leukemia which have had an impact on the improvement of the patients’ lives. Here below are the new trends that have emerged:

Menin Inhibitors for Acute Leukemia

Menin inhibitors appear contemporary as a group of targeted drugs filled in acute leukemias through particular genetic mutations. From this trial and other research studies, Revumenib has been identified to be effective in treating leukemias with KMT2A rearrangements taking advantage of this new target. ​

CAR T-Cell Therapy Enhancements

Chimeric Antigen Receptor (CAR) T-cell now has progressive improvement:​

• New approvals were as follows: brexucabtagene autoleucel (Tecartus) for relapsed or refractory B-cell acute lymphoblastic leukemia (ALL) as a new application of CAR T-cell therapy. ​
• New generation cells: Autolus also created a CAR T-cell therapy with a shorter interaction with cancer cells in order to lower the toxicity of the product while making it as effective as possible. ​

Combination Therapies in Clinical Trials

From the recent clinical trials the various researchers have looked into the possibilities of using the combination therapies:

• AML Treatment: A combination of a first-in-class CDK9 inhibitor, revumenib, venetoclax and decitabine was observed to have an 82% objective response rate for relapsed or refractory AML patients, out of which almost 49% were a complete remission. ​
• CLL Treatment: A phase II trial for untreated CLL patients used pirtobrutinib, obinutuzumab, and venetoclax and the rate of undetectable measurable residual disease was high. ​

Advancements in Chronic Myeloid Leukemia (CML) Treatment

Asciminib (Scemblix) was approved by the FDA in CML for its mechanism of action that is linked to the specific targeting of the ABL myristoyl pocket for patients who have been resistant or intolerant to prior treatments. ​
These are changes that point to the trend showing that the treatment of leukemia is continuously evolving to focus on the specific type and targeted treatment for better prognosis.