Editing Leukemia (section)

==Treatment==
Most forms of leukemia are treated with pharmaceutical [[medication]], typically combined into a multi-drug [[chemotherapy regimen]]. Some are also treated with [[radiation therapy]]. In some cases, a [[bone marrow transplant]] is effective.

===Acute lymphoblastic===
{{Further|Acute lymphoblastic leukemia#Treatment}}
Management of ALL is directed towards control of bone marrow and systemic (whole-body) disease. Additionally, treatment must prevent leukemic cells from spreading to other sites, particularly the [[central nervous system]] (CNS); periodic lumbar punctures are used for diagnostic purposes and to administer intrathecal prophylactic methotrexate.<ref>{{cite journal |vauthors=Gaietto A, Panetta JC, Pauley JL, Relling MV, Ribeiro R, Ehrhardt MJ, Pui CH, Inaba H, Swanson HD |title=Ommaya reservoir use in pediatric ALL and NHL: a review at St. Jude Children's Research Hospital |journal=Cancer Chemother Pharmacol |volume=93 |issue=6 |pages=617–625 |date=June 2024 |pmid=38416167 |doi=10.1007/s00280-024-04653-9 }}</ref> In general, ALL treatment is divided into several phases:
* ''Induction chemotherapy'' to bring about bone marrow remission. For adults, standard induction plans include [[prednisone]], [[vincristine]], and an [[anthracycline]] drug; other drug plans may include [[L-asparaginase]] or [[cyclophosphamide]]. For children with low-risk ALL, standard therapy usually consists of three drugs (prednisone, L-asparaginase, and vincristine) for the first month of treatment.
* ''Consolidation therapy'' or ''intensification therapy'' to eliminate any remaining leukemia cells. There are many different approaches to consolidation, but it is typically a high-dose, multi-drug treatment that is undertaken for a few months. People with low- to average-risk ALL receive therapy with [[antimetabolite]] drugs such as [[methotrexate]] and [[6-mercaptopurine]] (6-MP). People who are high-risk receive higher drug doses of these drugs, plus additional drugs.
* ''[[Central nervous system prophylaxis|CNS prophylaxis]]'' (preventive therapy) to stop cancer from spreading to the brain and nervous system in high-risk people. Standard [[prophylaxis]] may include radiation of the head and/or drugs delivered directly into the spine.
* ''Maintenance treatments'' with chemotherapeutic drugs to prevent disease recurrence once remission has been achieved. Maintenance therapy usually involves lower drug doses and may continue for up to three years.
* Alternatively, ''[[allogeneic bone marrow transplantation]]'' may be appropriate for high-risk or relapsed people.<ref>{{cite book| vauthors = Hoffbrand AV, Moss PA, Pettit JE |title=Essential haematology|date=2006|publisher=Blackwell Pub. |location=Malden, Mass. |isbn=978-1-4051-3649-5 |edition=5th}}</ref>

===Chronic lymphocytic===
{{Further|Chronic lymphocytic leukemia#Treatment}}

====Decision to treat====
[[Hematologist]]s base CLL treatment on both the stage and symptoms of the individual person. A large group of people with CLL have low-grade disease, which does not benefit from treatment. Individuals with CLL-related complications or more advanced disease often benefit from treatment. In general, the indications for treatment are:
* Falling [[hemoglobin]] or [[platelet]] count
* Progression to a later stage of disease
* Painful, disease-related overgrowth of [[lymph node]]s or [[spleen]]
* An increase in the rate of [[lymphocyte]] production<ref>{{cite web |url=http://www.cancer.gov/cancertopics/pdq/treatment/CLL/HealthProfessional/page2 |title=Chronic Lymphocytic Leukemia (PDQ) Treatment: Stage Information |author=National Cancer Institute |access-date=4 September 2007 |url-status=live |archive-url=https://web.archive.org/web/20071017143320/http://www.cancer.gov/cancertopics/pdq/treatment/CLL/HealthProfessional/page2 |archive-date=17 October 2007  |date=1 January 1980 }}</ref>

====Treatment approach====
Most CLL cases are incurable by present treatments, so treatment is directed towards suppressing the disease for many years, rather than curing it. The primary chemotherapeutic plan is [[polytherapy|combination]] chemotherapy with [[chlorambucil]] or [[cyclophosphamide]], plus a [[corticosteroid]] such as [[prednisone]] or [[prednisolone]]. The use of a corticosteroid has the additional benefit of suppressing some related autoimmune diseases, such as [[Warm autoimmune hemolytic anemia|immunohemolytic anemia]] or [[Idiopathic thrombocytopenic purpura|immune-mediated thrombocytopenia]]. In resistant cases, [[monotherapy|single-agent]] treatments with nucleoside drugs such as [[fludarabine]],<ref>{{cite journal | vauthors = Eichhorst BF, Busch R, Hopfinger G, Pasold R, Hensel M, Steinbrecher C, Siehl S, Jäger U, Bergmann M, Stilgenbauer S, Schweighofer C, Wendtner CM, Döhner H, Brittinger G, Emmerich B, Hallek M | title = Fludarabine plus cyclophosphamide versus fludarabine alone in first-line therapy of younger patients with chronic lymphocytic leukemia | journal = Blood | volume = 107 | issue = 3 | pages = 885–891 | date = February 2006 | pmid = 16219797 | doi = 10.1182/blood-2005-06-2395 | doi-access = free }}</ref> [[pentostatin]], or [[cladribine]] may be successful. Younger and healthier people may choose [[allogeneic]] or [[autologous]] [[bone marrow transplantation]] in the hope of a permanent cure.<ref>{{cite journal | vauthors = Gribben JG | title = Stem cell transplantation in chronic lymphocytic leukemia | journal = Biology of Blood and Marrow Transplantation | volume = 15 | issue = 1 Suppl | pages = 53–58 | date = January 2009 | pmid = 19147079 | pmc = 2668540 | doi = 10.1016/j.bbmt.2008.10.022 }}</ref>

===Acute myelogenous===
{{Further|Acute myeloid leukemia#Treatment}}

Many different anti-cancer drugs are effective for the treatment of AML. Treatments vary somewhat according to the age of the person and according to the specific subtype of AML. Overall, the strategy is to control bone marrow and systemic (whole-body) disease, while offering specific treatment for the central nervous system (CNS), if involved.<ref>{{Cite book | vauthors = Baig MQ |url=https://books.google.com/books?id=Dc8nDwAAQBAJ&pg=PA438 |title=Practical Radiotherapy & Chemotherapy Planning |date=2017-03-22 |publisher=JP Medical Ltd |isbn=978-93-86150-01-1 |language=en}}</ref>

In general, most oncologists rely on combinations of drugs for the initial, ''induction phase'' of chemotherapy. Such combination chemotherapy usually offers the benefits of early [[remission (medicine)|remission]] and a lower risk of disease resistance. ''Consolidation'' and ''maintenance'' treatments are intended to prevent disease recurrence. Consolidation treatment often entails a repetition of induction chemotherapy or the intensification of chemotherapy with additional drugs. By contrast, maintenance treatment involves drug doses that are lower than those administered during the induction phase.<ref>{{cite web|url=http://www.cancer.org/cancer/leukemia-acutemyeloidaml/detailedguide/leukemia-acute-myeloid-myelogenous-treating-typical-treatment-of-aml|title=Typical treatment of acute myeloid leukemia (except promyelocytic M3)|author=American Cancer Society|date=22 March 2012|work=Detailed Guide: Leukemia — Acute Myeloid (AML)|publisher=American Cancer Society|access-date=31 October 2012|url-status=live|archive-url=https://web.archive.org/web/20121112202809/http://www.cancer.org/cancer/leukemia-acutemyeloidaml/detailedguide/leukemia-acute-myeloid-myelogenous-treating-typical-treatment-of-aml|archive-date=12 November 2012}}</ref>

===Chronic myelogenous===
{{Further|Chronic myelogenous leukemia#Treatment}}

There are many possible treatments for CML, but the standard of care for newly diagnosed people is [[imatinib]] (Gleevec) therapy.<ref name="pmid17970609">{{cite journal | vauthors = Fausel C | title = Targeted chronic myeloid leukemia therapy: seeking a cure | journal = Journal of Managed Care Pharmacy | volume = 13 | issue = 8 Suppl A | pages = 8–12 | date = October 2007 | pmid = 17970609 | doi = 10.18553/jmcp.2007.13.s8-a.8 | pmc = 10437886 | url = http://www.amcp.org/data/jmcp/pages%208-12.pdf | url-status = dead | access-date = 18 May 2008 | archive-url = https://web.archive.org/web/20080528041331/http://www.amcp.org/data/jmcp/pages%208-12.pdf | archive-date = 28 May 2008 }}</ref> Compared to most anti-cancer drugs, it has relatively few side effects and can be taken [[Mouth|orally]] at home. With this drug, more than 90% of people will be able to keep the disease in check for at least five years,<ref name="pmid17970609"/> so that CML becomes a chronic, manageable condition.

In a more advanced, uncontrolled state, when the person cannot tolerate imatinib, or if the person wishes to attempt a permanent cure, then an allogeneic bone marrow transplantation may be performed. This procedure involves high-dose chemotherapy and radiation followed by infusion of bone marrow from a compatible donor. Approximately 30% of people die from this procedure.<ref name="pmid17970609"/>

===Hairy cell===
{{Further|Hairy cell leukemia#Treatment}}

'''Decision to treat'''<br />
People with hairy cell leukemia who are symptom-free typically do not receive immediate treatment. Treatment is generally considered necessary when the person shows signs and symptoms such as low blood cell counts (e.g., infection-fighting neutrophil count below 1.0&nbsp;K/μL), frequent infections, unexplained bruises, anemia, or fatigue that is significant enough to disrupt the person's everyday life.<ref>{{cite web |url=https://www.lecturio.com/concepts/hairy-cell-leukemia/| title=Hairy Cell Leukemia
|website=The Lecturio Medical Concept Library |access-date= 24 July 2021}}</ref>

'''Typical treatment approach'''<br />
People who need treatment usually receive either one week of [[cladribine]], given daily by intravenous infusion or a simple injection under the skin, or six months of [[pentostatin]], given every four weeks by intravenous infusion. In most cases, one round of treatment will produce a prolonged remission.<ref>{{cite journal | vauthors = Robak T, Jamroziak K, Gora-Tybor J, Blonski JZ, Kasznicki M, Dwilewicz-Trojaczek J, Wiater E, Zdunczyk A, Dybowicz J, Dmoszynska A, Wojtaszko M, Zdziarska B, Calbecka M, Kostyra A, Hellmann A, Lewandowski K, Stella-Holowiecka B, Sulek K, Gawronski K, Skotnicki AB, Nowak W, Zawilska K, Molendowicz-Portala L, Kloczko J, Sokolowski J, Warzocha K, Seferynska I, Ceglarek B, Konopka L | title = Cladribine in a weekly versus daily schedule for untreated active hairy cell leukemia: final report from the Polish Adult Leukemia Group (PALG) of a prospective, randomized, multicenter trial | journal = Blood | volume = 109 | issue = 9 | pages = 3672–5 | date = May 2007 | pmid = 17209059 | doi = 10.1182/blood-2006-08-042929 | doi-access = free }}</ref>

Other treatments include [[rituximab]] infusion or self-injection with [[Interferon-alpha]]. In limited cases, the person may benefit from ''[[splenectomy]]'' (removal of the [[spleen]]). These treatments are not typically given as the first treatment because their success rates are lower than cladribine or pentostatin.<ref>{{cite journal | vauthors = Saven A, Burian C, Adusumalli J, Koziol JA | title = Filgrastim for cladribine-induced neutropenic fever in patients with hairy cell leukemia | journal = Blood | volume = 93 | issue = 8 | pages = 2471–7 | date = April 1999 | pmid = 10194424 | doi = 10.1182/blood.V93.8.2471 }}</ref>

===T-cell prolymphocytic===
{{Further|T-cell prolymphocytic leukemia#Treatment}}

Most people with T-cell prolymphocytic leukemia, a rare and aggressive leukemia with a median survival of less than one year, require immediate treatment.<ref name="pmid11535503">{{cite journal | vauthors = Dearden CE, Matutes E, Cazin B, Tjønnfjord GE, Parreira A, Nomdedeu B, Leoni P, Clark FJ, Radia D, Rassam SM, Roques T, Ketterer N, Brito-Babapulle V, Dyer MJ, Catovsky D | title = High remission rate in T-cell prolymphocytic leukemia with CAMPATH-1H | journal = Blood | volume = 98 | issue = 6 | pages = 1721–6 | date = September 2001 | pmid = 11535503 | doi = 10.1182/blood.V98.6.1721 | s2cid = 26664911 | doi-access = free }}</ref>

T-cell prolymphocytic leukemia is difficult to treat, and it does not respond to most available chemotherapeutic drugs.<ref name="pmid11535503" /> Many different treatments have been attempted, with limited success in certain people: [[purine analogues]] (pentostatin, fludarabine, cladribine), [[chlorambucil]], and various forms of combination chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone [[CHOP (chemotherapy)|CHOP]], cyclophosphamide, vincristine, prednisone [COP], vincristine, doxorubicin, prednisone, etoposide, cyclophosphamide, bleomycin [[VAPEC-B]]). [[Alemtuzumab]] (Campath), a [[monoclonal antibody]] that attacks white blood cells, has been used in treatment with greater success than previous options.<ref name="pmid11535503" />

Some people who successfully respond to treatment also undergo [[stem cell transplantation]] to consolidate the response.<ref name="pmid11535503" />

===Juvenile myelomonocytic===
Treatment for [[juvenile myelomonocytic leukemia]] can include [[splenectomy]], [[chemotherapy]], and [[bone marrow transplantation]].<ref>{{cite web|url=http://www.jmmlfoundation.org/modules.php?name=Content&pa=showpage&pid=8/ |title=JMMLfoundation.org |publisher=JMMLfoundation.org |access-date=29 August 2010 |url-status=dead |archive-url=https://web.archive.org/web/20090125041058/http://www.jmmlfoundation.org/modules.php?name=Content&pa=showpage&pid=8%2F |archive-date=25 January 2009 }}</ref>