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Systemic chemotherapy aims to eradicate leukemic cells and induce remission (less than 5% of blast cells in the marrow and peripheral blood are normal). Chemo-therapy varies:
❑Meningeal leukemia — intrathecal instillation of methotrexate or cytarabine with cranial radiation.
❑ALL — vincristine, prednisone, high-dose cytarabine, l-asparaginase, AMSA, and daunorubicin. Because there's a 40% risk of meningeal leukemia in ALL, intrathecal methotrexate or cytarabine is given. Radiation therapy is given for testicular infiltration.
❑AML — a combination of I.V. daunorubicin and cytarabine or, if these fail to induce remission, a combination of cyclophosphamide, vincristine, prednisone, or methotrexate; high-dose cytarabine alone or with other drugs; amsacrine; etoposide; and 5-azacytidine and mitoxantrone. A subtype of AML called acute promyelocytic leukemia (APL) is treated with all-transretinoic acid (ATRA), which causes leukemic cells to mature into normal WBCs. ATRA has increased the cure rate of this type of AML. Arsenic trioxide has been approved for patients with APL who have failed ATRA as the usual chemotherapy.
❑Acute monoblastic leukemia — cytarabine and thioguanine with daunorubicin or doxorubicin.
Bone marrow transplant or a stem-cell transplant may be possible. Treatment also may include antibiotic, antifungal, and antiviral drugs and granulocyte injections to control infection and transfusions of platelets to prevent bleeding and of red blood cells to prevent anemia.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Systemic chemotherapy includes alkylating agents — usually chlorambucil, cyclophosphamide, vincristine, or fludarabine (singly or in combination) — and steroids (prednisone) when autoimmune hemolytic anemia or thrombocytopenia occurs.
An advance in the treatment of CLL has been the emergence of the humanized monoclonal antibodies rituximab and alemtuzumab. Alemtuzumab acts as an antibody against the surface of CLL cells and is used when fludarabine fails. Rituximab, a monoclonal antibody, acts similiarly to alemtuzumab; studies are ongoing.
When chronic lymphocytic leukemia causes obstruction or organ impairment or enlargement, local radiation treatment can be used to reduce organ size. Allopurinol can be given to prevent hyperuricemia, a relatively uncommon finding.
Prognosis is poor if anemia, thrombocytopenia, neutropenia, bulky lymphadenopathy, and severe lymphocytosis are present.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Systemic chemotherapy aims to eradicate leukemic cells and induce remission. Chemotherapy varies according to the type of leukemia:
❑ meningeal leukemia — intrathecal instillation of methotrexate or cytarabine with cranial radiation is used.
❑ ALL — vincristine, prednisone, methotrexate, 6-mercaptopurine, and cyclophosphamide are used. Intrathecal therapy may be required. Radiation therapy is given for testicular infiltration.
❑ AML — a combination of I.V. chemotherapeutic drugs is used. In acute promyelocytic leukemia, a type of AML, all-trans retinoic acid is used to cause leukemia cells to mature into normal WBCs. It’s used in remission and increases the cure rate of AML. If this drug fails, arsenic trioxide may help.
❑ acute monoblastic leukemia — cytarabine and thioguanine with daunorubicin or doxorubicin is used.
A bone marrow or stem cell transplant may be possible. Treatment also may include antibiotic, antifungal, and antiviral drugs and granulocyte injections to control infection. Platelet transfusions (to prevent bleeding) and red blood cell transfusions (to prevent anemia) may also be given.
Source: Handbook of Diseases, 2003
Systemic chemotherapy includes an alkylating drug, usually chlorambucil or cyclophosphamide, and sometimes a steroid (prednisone) when autoimmune hemolytic anemia or thrombocytopenia occurs.
When chronic lymphocytic leukemia causes obstruction or organ impairment or enlargement, local radiation treatment can be used to reduce organ size. Allopurinol can be given to prevent hyperuricemia, a relatively uncommon finding.
Source: Handbook of Diseases, 2003
Aggressive chemotherapy has so far failed to produce remission in patients with CGL. Consequently, the goal of treatment in the chronic phase is to control leukocytosis and thrombocytosis. The most commonly used oral drugs are busulfan and hydroxyurea. Aspirin is commonly given to prevent stroke if the patient’s platelet count exceeds 1 million/µl.
Ancillary CGL treatments include:
❑ local splenic radiation or splenectomy to increase platelet count and decrease adverse effects related to splenomegaly
❑ leukapheresis (selective leukocyte removal) to reduce leukocyte count
❑ allopurinol to prevent secondary hyperuricemia or colchicine to relieve gout due to elevated serum uric acid levels
❑ prompt treatment of infections that may result from chemotherapyinduced bone marrow suppression.
During the acute phase of CGL, lymphoblastic or myeloblastic leukemia may develop. Treatment is similar to that for acute lymphoblastic leukemia. Remission, if achieved, is commonly short lived. Bone marrow or stem cell transplantation may help in certain phases of CGL. Despite vigorous treatment, CGL usually progresses after the onset of the acute phase.
For more information on treatment during the acute phase, see “Leukemia, acute,” page 484.
Source: Handbook of Diseases, 2003
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