ADULT LEUKEMIA

Leukemia treatment making strides

2013-10-16T00:00:00Z 2013-10-21T16:17:23Z Leukemia treatment making stridesCarrie Rodovich nwitimes.com
October 16, 2013 12:00 am  • 

Although treatment for leukemia can be complicated and the cure success rate can vary based on a patient’s age and overall health, oncologists are hopeful that recent strides in treatment may have an impact on a countless number of patients.

There are several types of leukemia, which is defined as an abnormal proliferation of white blood cells, says Dr. Bennett Caces, a hematologist oncologist on staff at Ingalls Memorial Hospital.

The most common types of leukemia in adults are acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) and are treated in similar ways.

“AML is still thought to be a disease of the older population, and incidents go up as we get older,” Dr. Caces says. “The median age of diagnosis is 66 years old.”

Doctors say one of the major advances in leukemia research is understanding the composition of the disease, which makes it easier to determine a course of treatment. Looking at genetic markers helps classify the treatment into three categories that gauge treatment successes. 

“Before, we would lump all AML patients into a category with three or four subcategories,” Dr. Caces says. “Now we can categorize them as AML, but give them a good prognosis, intermediate and poor prognosis. This is important, because it helps physicians proceed with treatment.”

For leukemia patients, the first step in treatment is induction chemotherapy, which is designed to help bring patients into remission. 

For most AML patients, Dr. Caces says, the only cure will come from a stem cell transplant, either from a donor relative or someone on the donor registry. The transplant follows chemotherapy, if chemotherapy has brought a patient into remission. 

Dr. Caces says there is still room for improvement in the leukemia survival rates, but recent developments have given researchers, patients and oncologists hope that there might be new treatment options on the horizon.

Chemotherapy has worked for decades because it kills cancer by attacking any cells in the body that divide quickly, Dr. Caces says. That’s why a chemotherapy patient loses their hair or gets diarrhea, because the hair and the lining of the gut have cells that divide rapidly.

But a new form of therapy—called targeted therapies—rely on chemical agents to target something specific on the cancer cell, which will help leave the normal, non-cancerous cells intact. 

Dr. Alan Tan, an oncologist with Premier Hematology Oncology Associates who is also a staff physician at St. Margaret Health, says chronic leukemia (CLL) patients are benefiting from a targeted therapy drug called ibrutinib.

“It’s the closest thing to a miracle drug that we’ve seen in the last decade or so,” Dr. Tan says. “It’s not just a generic killer, it targets the pathway of the cancer.”

Patients who were not otherwise responding to traditional chemotherapy treatments or are not eligible for transplants have seen an increased success rate when using this drug, he says. 

Right now, treating leukemia with targeted therapies is being used in trial studies and in larger cancer centers, both oncologists says. 

“Right now, they’re being used together with chemotherapy,” Dr. Caces says. “Chemo is still a good part of treatment, overall. But some patients with AML, especially the elderly, could not ever tolerate a strong regimen of chemo, but they can get the targeted therapy on its own.”

Dr. Caces says it is important for people to be willing to participate in clinical trials, not only because it could help with their own treatment, but it could also help improve treatment options for future generations.

“Ultimately, the more we study these things, the more chances we have for improving the outcomes,” he says. “For these clinical trials to move forward, we need people willing to participate in the studies.”

Dr. Tan agreed, and says that trials randomize patients to determine who gets standard care and who gets additional experimental drugs. 

“There more people we enroll into clinical trials, the more it benefits everyone else,” he says. “Especially with leukemia that is difficult to treat, and there is nothing else to offer as far as a good, curative therapy.”

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