Some leukemias respond well to treatment, while others are more stubborn. Very slow growing cancers may not require any medical intervention for several years. You and your doctor will likely discuss the benefits and risks of each potential therapy before deciding on a treatment. (1)

Therapies Used to Treat Leukemia

Chemotherapy

Chemotherapy uses medication to kill leukemia cells in your body. It can be given as a pill, an under-the-skin injection, or an injection into the bloodstream. Sometimes, chemo is also delivered to the fluid surrounding the brain and spinal cord, in what’s known as intrathecal chemotherapy. (2) Acute leukemias, such as acute myelogenous leukemia (AML) and acute lymphocytic leukemia (ALL), are typically treated in three stages. First, patients receive “induction chemo” to induce remission. During this phase, the chemo medicines are used to kill as many leukemia cells as possible, while bringing blood counts back to normal. Next, “consolidation therapy” is given to destroy any remaining leukemia cells that aren’t found in blood or marrow tests. The last stage of chemo, called “maintenance therapy,” is commonly recommended as a final course of treatment in some types of acute leukemia. (3) Chronic leukemias, such as chronic lymphocytic leukemia (CLL) and chronic myelogenous leukemia (CML), may be treated with chemotherapy, newer targeted therapies, or a combination of chemo and other treatments. Side effects depend on the chemo drug you’re given and may include:

FatigueNauseaHair lossMouth soresTaste changesNerve damageHeart damageProblems with sexual function

Some examples of targeted drugs are:

imatinib (Gleevec)dasatinib (Sprycel)nilotinib (Tasigna)bosutinib (Bosulif)ponatinib (Iclusig)midostaurin (Rydapt)enasidenib (Idhifa) (4,5)

Certain targeted therapies are designed for specific types of leukemia. Your doctor can help you figure out if you’re a candidate for targeted treatment. Side effects of these drugs are usually mild but may include:

DiarrheaNauseaFatigueSkin rashesMuscle pain (6)

Biological Therapy

Biological therapies are substances that work on the immune system, helping it fight cancer. Some biological medicines used to treat leukemia are:

alemtuzumab (Lemtrada)obinutuzumab (Gazyva)ofatumumab (Arzerra)rituximab (Rituxan)blinatumomab (Blincyto)inotuzumab ozogamicin (Besponsa) (7,8,9)

These drugs are often given along with chemotherapy or other treatments. Side effects of biological therapy may include fever, chills, headache, nausea, and fatigue. Researchers are also testing immunotherapy to treat certain forms of leukemia. (10)

CAR T-Cell Therapy

One newer type of immunotherapy, known as chimeric antigen receptor (CAR) T-cell therapy, involves removing specific immune cells from a person’s blood and altering them in the lab to improve their ability to find and fight cancer cells. The cells are then infused back into the patient, so they can seek out and kill leukemia cells. (1) Studies of CAR T-cell therapy have shown potential in the treatment of chronic lymphocytic leukemia (CLL). But to date, CAR T-cell therapy has only received FDA approval for treatment of B-cell acute lymphoblastic leukemia (B-ALL). These two drugs are approved for treating a subtype of B-ALL called B-cell precursor ALL:

tisagenlecleucel (Kymriah) This drug is approved for patients ages 25 and under whose cancer is not responding to treatment or has come back after treatment two or more times.brexucabtagene autoleucel (Tecartus) This drug is approved for adults whose cancer is not responding to treatment or has come back after treatment.

CAR T-cell therapy can cause side effects ranging from very high fevers and low blood pressure to neurological toxicities such as confusion and delirium. Patients given CAR T-cell therapy will be monitored for a serious side effect called cytokine release syndrome, which is characterized by inflammation that presents as fever and affects multiple organs in the body. This complication can be severe and may need intensive care treatment to control. (12) RELATED: CAR T-Cell Therapy Enhances the Human Immune Response to Cancer

Radiation

Radiation therapy uses X-rays or other forms of energy to target leukemia cells. This treatment is sometimes used to prepare you for a stem cell transplant. (13) Radiation is often combined with other therapies. Possible side effects might include:

Increased risk for infectionFatigueNauseaDiarrheaSkin irritationLoss of appetite (13)

Stem Cell Transplant

A stem cell transplant, which is also called a bone marrow transplant, is a medical procedure used to replace your bad bone marrow with healthy bone marrow. (14) You’ll receive high doses of chemo or radiation or a combination of both to destroy your diseased bone marrow before having the transplant. Then, you’ll be given an infusion of blood-forming stem cells. There are two types of stem cell transplants:

Autologous With this type of transplant, you can use your own stem cells. The cells are removed from your blood, harvested, frozen, and then infused back into your body.Allogeneic Stem cells are taken from a matching donor, such as a close relative, and then injected into your body. Sometimes, donor sources might include umbilical cord blood or an unrelated donor. This is the main type of transplant used to treat acute leukemias. (1,15)

Allogeneic transplants are considered riskier than autologous transplants because they can cause a serious complication known as graft-versus-host disease. This occurs when the donor’s cells attack the patient’s healthy tissues and organs. (16) You will be given medicine to help prevent graft-versus-host disease.

Who Can Watch and Wait?

Some very slow growing leukemias, like CLL, may not require treatment right away. Your doctor may recommend a “watch and wait” approach. This means your healthcare provider will monitor your cancer without offering any treatment until it becomes necessary. Studies show there are no benefits to treating certain forms of slow-growing leukemia early on. (17)

Clinical Trials: Should You Participate in One?

Participating in a clinical trial may allow you to receive a new therapy that’s not available to the public. Research studies also help doctors determine if new treatments are safe and effective. The Leukemia and Lymphoma Society offers special resources to help guide you through the clinical trial process.

Complementary Therapies for Symptomatic Relief

While alternative medicine won’t cure leukemia, some therapies may help you cope with anxiety, pain, and treatment side effects. Common approaches include:

AcupunctureMassageMusic therapyHypnosisExerciseMeditationYoga or tai chi

If you’re interested in trying an alternative medicine approach, talk to your doctor for more details. (18)

Making Treatment Decisions

It’s not always easy to choose a leukemia treatment plan. There are lots of options and decisions to make. You and your physician should work together to come up with the best approach. When recommending a treatment plan, your doctor will probably take several factors into account, including:

The type of leukemia you haveWhether your disease is slow- or fast-growingYour ageYour overall healthWhether your disease has spread to other areas of your bodyWhether a good donor match is available, in case a transplant is an option

It’s important to find a doctor you’re comfortable around. A blood cancer specialist will probably be most knowledgeable about your options. (1)