Leukemia: Treatment and Treatment
chronic leukemia | ¿Qué es leukemia lymphocítica crónica?
myelocytic leukemia
acute myelogenous leukemia
acute myeloblastic leukemia
anti money laundering act
money laundering regulations
chronic myeloid leukemia
what is leukemia
aml compliance
General indicationsTherapy approachTherapy choiceTherapy methods Active surveillanceChemiotherapyTyrosine-kinase inhibitorsHydatopoietic growth factorsImmunotherapyRadiotherapyOther treatments
General indications
 |
| leukemia |
Therapeutic approach
The treatment of leukemia is constantly evolving and provides several options: the decision to undertake a specific therapeutic line is based on the specific clinical case; the choice of therapy depends on a number of factors, including:
The type of leukemia (acute or chronic);
Blood values and outcomes of other diagnostic investigations, which among other things allow to determine the characteristics of tumor cells;
Stage / phase of the disease;
The age of the patient;
General health conditions (presence of symptoms, other concomitant diseases ...).
The purpose of the therapy can be of type:
Curative, if it is possible to aim at the healing of leukemia;
Palliative: when - being unlikely to be able to eliminate the pathological condition - we try to improve the quality of life, trying to regress cancer cells to slow the progression of leukemia.
In addition, there are medical and / or psycho-oncological support therapies that help alleviate ailments such as pain, feelings of fear or psychological burden.Choice of therapy
Leukemia treatments differ mainly due to their therapeutic action and their tolerability. The oncologist or haematologist can discuss with the patient the most appropriate therapeutic plan, explaining in detail the methods by which it will be implemented and the results that can be achieved.
Often, a multidisciplinary approach is required for the treatment of a leukemic patient: primary therapy can be performed under the direction of a medical oncologist, haematologist and radiotherapist. Sometimes, different substances or methods are combined synergistically to obtain the best outcome from the therapy. At the time of diagnosis, a routine eye assessment must also be established, as the lesions, which are dependent on the visual apparatus, may be asymptomatic.
Some therapeutic methods can be applied repeatedly, if the disease recurs after a first operation, or an alternative treatment plan can be used.
In the case of an acute leukemia the decision on which therapy to take should be sudden, since the disease is characterized by a rapid progression, which can quickly lead to death, if not treated.
What is the difference between healing and remission?
In oncology it is difficult to talk about a real cure, because sometimes the disease can reappear even after some time. Depending on the type of tumor, doctors have established a period of time after which a patient can be reasonably recovered if, despite periodic careful checks, the disease does not cause any manifestation. The term "remission" means an attenuation or disappearance of symptoms caused by a tumor; in particular, the term partial remission indicates the disappearance of only some signs of the disease. The treatment produces complete remission of the disease if there are no more traces of leukemia detectable with the diagnostic means available, although there is no certainty that the tumor has been completely eliminated. However, the longer the remission phase lasts, the greater the chances that the tumor will be definitively eradicated: healing is achieved when total remission is maintained for several years.
Therapeutic methods
The doctor determines the possibilities of treatment of leukemia on the basis of age, general health, the type of leukemia affected and the spread of cancer in other parts of the body.
Treatments for leukemia provide several possibilities:
Active surveillance
In the case of some forms of leukemia with very slow progression and in certain clinical conditions, the therapy can be postponed (example: chronic lymphatic leukemia, LLC). The doctor monitors the patient's health during periodic checks, postponing the start of treatment until the first symptoms or troublesome symptoms occur, such as fever, swelling of the lymph nodes or spleen or difficulty breathing. The appearance of clinical signs such as anemia and the drastic decrease in the number of platelets makes the therapy necessary. In the case of acute leukemia you should never wait, but always start therapy as soon as possible.
Chemotherapy
Systemic chemotherapy (with or without radiotherapy) is the main form of treatment for most types of leukemia. It is a treatment that uses a single drug or a combination of chemicals to kill leukemic cells or stop their proliferation. The basic strategy is to spread cytostatic agents in the body through the blood vessels, able to produce a systemic effect, interfering with cell division and preventing the leukemic cells from multiplying.
In this way, the direct treatment to the neoplasia provokes effects also on healthy cells and tissues (example: blood elements in the bone marrow, cells of the hair follicles or mucous membranes etc.). The damage of the healthy and normal cellular component is the main cause of the various side effects of chemotherapy, which regress after the end of the therapeutic session.
Chemotherapy cycles are performed as an outpatient or inpatient procedure. A combination of different chemotherapeutics is often provided, which can be administered:
Intravenous: the therapy lasts several months (in cycles, with breaks between sessions).
Orally: Chemotherapy with tablets can continue throughout life.
The different types of treatment can be:monochemotherapy
Multi-pharmacological therapy: involves the synergistic exploitation of the different mechanisms of action of active drugs in monochemotherapy.
Myeloablative chemotherapy: high dose therapy performed to increase the chances that the leukemic cells are destroyed (usually precedes a transplant of stem cells or bone marrow). The bone marrow is particularly affected by undesirable effects, as it is completely destroyed and must be subsequently rebuilt: following treatment with a high dose of cytostatics, stem cells are transplanted. The duration of the procedure, performed in hospitalization, varies from one to three months and, in general, you leave the hospital after several weeks from the transplant.
Stages of the therapy of a chemosensitive neoplasm
Step Mode Meaning
1 Induction of complete remission Reduction of tumor mass. Elimination of any clinically detectable signs of disease (with standard techniques). Multi-pharmacological therapy at standard or high dose dosage with haematopoietic growth factors.
2 Consolidation of complete remission Reduction of residual neoplastic mass after induction. Therapy (with cross-resistant drugs) with support of growth factors.
3 Maintenance cyclic re-induction Minimum residual disease containment. Periodic therapy with various combinations of drugs (non-myeloablative).
Therapy with tyrosine kinase inhibitors
Some drugs specifically inhibit specific tyrosine kinases (enzymes able to transfer phosphate groups from high-energy donor molecules, such as ATP, to specific substrates during a biochemical reaction). The tyrosine kinase inhibitors induce a slowdown in the proliferation of the leukemic cells and allow to control the progression of the disease. These drugs are indicated in cases of chronic myeloid leukemia (CML) and acute lymphatic leukemia (LLA Ph +): only active against tumor clones presenting the Philadelphia chromosome.
The tyrosine kinase inhibitors are taken orally (tablets). CML therapy is performed on an outpatient basis, while in the case of LLA, tyrosine-kinase inhibitors are administered in combination with chemotherapy in hospital.
An example is Imatinib mesylate (Glivec ®), a specific inhibitor of BCR / ABL kinase, used in the Ph + LMC therapy.
Hematopoietic growth factors
Hematopoietic growth factors are substances that stimulate the proliferation and differentiation of blood cells in the bone marrow and their diffusion from the organ to the bloodstream (eg, erythropoietin, thrombopoietin). This treatment is used in various forms of leukemia and in certain clinical conditions, even if it is not able to recover from leukemia.
Immunotherapy
Antibody and interferon therapy
Antibodies (Ab) are a fundamental component of the immune system: the body naturally produces these elements to protect against viruses, bacteria, etc. Some drugs are based on this consideration: Ab are synthesized (in the laboratory) for a specific biological target. The antibodies, inoculated in the patient, recognize a specific and unique receptor on the surface of the leukemic cells (they mark the tumor clones). In this way the body's natural immune component can selectively detect and destroy altered or undesired cells. Some antibodies can also be coupled to a cytostatic agent, to directly induce the relative substance to leukemic cells, allowing less damage to healthy cells. Antibodies are administered in several intravenous therapeutic cycles and the duration of treatment is variable.
Interferons (IFN), produced by synthesis (in the laboratory), stimulate the immune system with an aspecific effect, in the sense that they induce a general immune reaction: they act with an indirect mechanism on the survival of the leukemic cells, decreasing their cell adhesion and amplifying the activity of the cells of the immune system. The therapy provides subcutaneous injections to be performed daily.Radiotherapy
Leukemias are never treated exclusively with radiotherapy. The procedure involves the use of X-rays or high-energy in order to damage the leukemic cells and stop their growth. Irradiation can be indicated in various cases:
Total body radiotherapy, to supplement high-dose chemotherapy, during patient preparation for stem cell transplantation;
Local radiotherapy, for the localized manifestations of the disease not sufficiently controlled by drugs (example: central nervous system or testes).
Other treatments
If the splenomegaly is excessive, the doctor may recommend a surgical treatment to remove the spleen.
In the individual case, it is not possible to apply all the therapeutic methods described above, but sometimes it may be necessary to resort to a combination of different treatments. Particular therapeutic importance in leukemia patients is assumed by the transplantation of stem cells or bone marrow.
0 komentar:
Posting Komentar