Acute Myelogenous Leukemia
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Acute Myelogenous Leukemia (AML) Acute myelogenous leukemia (AML) is a fast-growing cancer of the blood and bone marrow. In AML, the bone marrow makes many unformed cells called blasts. Blasts normally de elo! into white blood cells that fight infection. "owe er, the blasts are abnormal in AML. #hey do not de elo! and cannot fight infections. #he bone marrow may also make abnormal red blood cells and !latelets. #he number of abnormal cells (or leukemia cells) grows $uickly. #hey crowd out the normal red blood cells, white blood cells and !latelets the body needs.
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8ther genetic abnormalities, e.g., -L#9 mutation, :0A*.
;octors also e1amine the !atient to find out if leukemia cells ha e s!read outside the blood and bone marrow. ;octors may use a chest <-ray and an ultrasound of the abdomen to look at the organs and tissues inside. #hey may also use a test called a lumbar !uncture (s!inal ta!) to find out whether there are leukemia cells in the fluid around the brain and s!inal cord. Treatment options for acute myelogenous leukemia AML can get worse $uickly, so doctors usually begin treatment right away. #o !lan treatment, doctors look at a !atient=s risk factors (also called !rognostic factors). 0isk factors are !atient and disease traits that clinical studies ha e linked to better or worse outcomes from treatment. >1am!les of risk factors are a !atient=s age and subty!e of AML. #o learn more about AML risk factors as well as how treatment o!tions may differ for children or for adults older than age +(, see 0isk -actors for 3lanning #reatment of AML. -or a !atient with AML, the treatment !lan may include6 • %hemothera!y 2 drugs that destroy cancer cells or sto! them from growing (described below). • A bone marrow or cord blood trans!lant (described below). • All-trans retinoic acid (A#0A) if he or she has the subty!e of AML known as !romyelocytic leukemia. • 8ther newer treatments that were recently de elo!ed or are still being studied in clinical trials 2 you can ask your doctor whether any newer treatments may be o!tions for you. /hiche er treatment you and your doctor choose, you may be asked to be !art of a clinical trial. > en standard treatments continue to be studied in clinical trials. #hese studies hel! doctors learn more about which treatments work best for which !atients. Chemotherapy for AML
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Acute myelogenous leukemia sym!toms and diagnosis #reatment o!tions for acute myelogenous leukemia %hemothera!y for AML Bone marrow or cord blood trans!lant for AML Making treatment decisions
Acute myelogenous leukemia symptoms and diagnosis AML is the most common ty!e of acute leukemia. More than &&,'(( new cases occur in the )nited *tates each year, mostly in older adults. #he a erage age of a !erson with AML is +, years. -ewer than &(. of !eo!le with AML are children. Acute myelogenous leukemia is also called acute myeloblastic leukemia, acute myeloid leukemia, acute granulocytic leukemia or acute nonlym!hocytic leukemia. Symptoms #he sym!toms of AML are caused by low numbers of healthy blood cells and high numbers of leukemia cells. • /hite blood cells fight infection. Low numbers can lead to fe er and fre$uent infections. • 0ed blood cells carry o1ygen throughout the body. Low numbers can lead to anemia 2 feeling tired or weak, being short of breath and looking !ale. • 3latelets control bleeding. Low numbers can lead to easy bleeding or bruising and tiny red s!ots under the skin (!etechiae). • "igh numbers of leukemia cells may cause !ain in the bones or 4oints. A !erson with AML may feel generally unwell and run-down. "e or she may also ha e other, less common sym!toms. Diagnosis AML is diagnosed when blood and bone marrow sam!les show a large number of leukemia cells. AML has eight subty!es, labeled M( through M5. #he subty!es are based on the ty!e of blood cells affected. #o find out the sub ty!e and how well the leukemia might res!ond to treatment, the sam!les are looked at to find6 • #he number of healthy blood cells. • #he si7e and number of leukemia cells. • #he changes that a!!ear in the chromosomes of the leukemia cells. #his is called cytogenetics.
nduction chemotherapy -or most !atients, the standard first !hase of AML treatment is induction chemothera!y. #he goal of induction chemothera!y is to bring the disease into remission. 0emission is when the !atient=s blood counts return to normal and bone marrow sam!les show no sign of disease (less than ,. of cells are leukemia cells). Induction chemothera!y is ery intense. It usually lasts one week, followed by three or more weeks for the !atient to reco er from the treatment. 8ften two drugs are used6 • %ytarabine (ara-%) • An anthracycline drug such as daunorubicin (;aunomycin) or idarubicin (Idamycin) *ome !atients may also be gi en additional drugs or different drugs. 3atients who ha e the AML subty!e !romyelocytic leukemia also are gi en all-trans retinoic acid (A#0A). If one week of treatment does not bring a remission, treatment may be re!eated once or twice. Induction brings a com!lete remission
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About 5(. to ?(. of adults under age +(. About ,(. of adults o er age +(. More than '(. of children.
If an allogeneic trans!lant may be an o!tion for you, your doctor will do a test to find out your "LA tissue ty!e. @our doctor will also test !ossible donors in your family to find out if they are a suitable match for you. In adults in good health with standard AML and a matched sibling, and allogeneic trans!lant may be considered after remission with induction thera!y. If you do not ha e a suitable donor in your family, your doctor can search the Be #he Match*M 0egistry for an unrelated donor or cord blood unit. #o sa e time, your doctor may check for !otential donors on the registry at the same time he or she is testing for donors in your family. #he closeness of the donor match can affect a !atient=s chances of a good trans!lant outcome. In general, trans!lants using matched sibling donors ha e had the best results. "owe er, outcomes for unrelated donor trans!lants ha e im!ro ed in the last decade. -or some grou!s of !atients, outcomes for sibling donor and unrelated donor trans!lants are similar. $educed%intensity and non%myeloa#lati&e transplants -or some !eo!le with AML, an allogeneic trans!lant may offer the best chance for a long-term remission. "owe er, more than half of !eo!le with AML are o er age +(. Many !eo!le older than age +( are unable to tolerate the intense treatment of a standard trans!lant. 3eo!le with other health !roblems, such as heart disease or organ damage from !re ious chemothera!y, may also be unable to tolerate a standard trans!lant. An allogeneic trans!lant using less intense treatment may be an o!tion for some of these !atients. #his ty!e of trans!lant is called a reduced-intensity trans!lant or nonmyeloablati e trans!lant. Transplant success rates #rans!lants ha e risks of serious com!lications, but a trans!lant offers some !atients the best chance for a long-term remission. If trans!lant is an o!tion for you, your doctor can talk with you about the !ossible risks and benefits of a trans!lant. -or statistics showing !atients= results after trans!lant, see AML #rans!lant 8utcomes. Making treatment decisions AML is an acute disease that can get worse $uickly. Most !atients begin treatment with induction chemothera!y soon after diagnosis. Many !atients reach remission, but rela!se of AML is common. All !atients need a second !hase of treatment to try to !re ent rela!se. #he second !hase of treatment is based on a !atient=s risk factors. (-or more information, see 0isk -actors for 3lanning #reatment of AML.) It is im!ortant to discuss your risk factors and your treatment o!tions with a doctor who is e1!erienced in treating AML.
*uccessful induction chemothera!y destroys most of the leukemia cells, but a few will be left in the body. If these cells are not destroyed, they can cause a rela!se of the disease. More treatment is needed to destroy the remaining leukemia cells. #he ne1t ste! may be consolidation chemothera!y or a trans!lant, de!ending on the treatment !lan. Consolidation chemotherapy #he second !hase of chemothera!y is often called consolidation chemothera!y. #he goal of consolidation chemothera!y is to destroy any remaining leukemia cells. A common treatment is high doses of cytarabine (ara-%) gi en in three or more cycles. ;octors may also use different drugs and schedules. %onsolidation chemothera!y is used to treat many !atients with AML. It is the standard treatment at first remission for adults with low-risk cytogenetic factors (changes in the chromosomes of leukemia cells), es!ecially adults younger than age +(. !one marro" or cord #lood transplant for AML -or some !atients, a bone marrow or cord blood trans!lant may offer the best chance for a long-term remission. A trans!lant is a strong treatment with risks of serious side effects, so it is not used for all !atients with AML. A trans!lant is used when chemothera!y alone is unlikely to !ro ide a long-term remission. Autologous transplant An autologous trans!lant uses blood-forming cells collected from the !atient. If an autologous trans!lant is a treatment o!tion for you, you will ha e blood-forming cells collected from your blood stream. #he cells are usually collected after one or two cycles of consolidation treatment. #he cells are fro7en until you are ready for trans!lant. @ou may recei e an autologous trans!lant soon after your induction thera!y is com!leted, or your cells may be sa ed as a backu! o!tion in case you rela!se after recei ing consolidation chemothera!y. Autologous trans!lants ha e risks of serious side effects, but these risks are lower than for allogeneic trans!lants. "owe er, a !atient has higher risks of a leukemia rela!se after an autologous trans!lant. #his is because leukemia cells may be returned to the !atient along with his or her blood-forming cells. Allogeneic transplant An allogeneic trans!lant re!laces the abnormal cells in a !atient=s bone marrow with healthy blood-forming cells from a family member or unrelated donor or cord blood unit. An allogeneic trans!lant has a higher risk of serious side effects than consolidation chemothera!y or an autologous trans!lant. "owe er, the risk of rela!se is lower after an allogeneic trans!lant. Choosing a donor or cord #lood unit
'lanning for a possi#le transplant
Blood cell de elo!ment. A blood stem cell goes through se eral ste!s to become a red blood cell, !la
All !atients with AML may want to talk with their doctors about including the !ossibility of a trans!lant in their treatment !lan. A trans!lant may be the first choice or it may be a backu! !lan. /hen trans!lant is not the first treatment, early !lanning may allow for more fle1ibility in treatment o!tions and a $uicker trans!lant later, if it is needed. In general, to !re!are for the !ossibility of trans!lant6 • 3atients with AML should be "LA tissue ty!ed at diagnosis. • 3atients should be referred to a trans!lant doctor for consultation at an a!!ro!riate time based on risk factors. • -amily members who might be suitable donors should be tested at the same time as the !atient or soon after. • ;octors can take an early look at !otential unrelated donors and cord blood units on the Be #he Match 0egistry as soon as they know the !atient=s "LA tissue ty!e. #his first look is free of charge. • 3atients who ha e no suitable related donor and few !otential unrelated donors may want to discuss storing their own blood-forming cells for a !ossible autologous trans!lant. #he only !atients who may not benefit from this !lanning are those who would clearly be unable to tolerate e en a reduced-intensity trans!lant. *ome older !atients and !atients who ha e organ damage or other health !roblems may be unable to tolerate a trans!lant. If you want to consider a trans!lant, a trans!lant doctor can e1amine you to see whether a trans!lant is a good o!tion. It is im!ortant to talk about your treatment o!tions with a doctor who is e1!erienced in treating AML. @our doctor can discuss your s!ecific risk factors and treatment o!tions with you. -or more information to hel! you talk to your doctor about whether a trans!lant is an o!tion for you, you can share the referral guidelines (3;-) from the 3hysician 0esources section of this /eb site with your doctor. %hronic myelogenous leukemia is a disease in which the bone marrow makes too many white blood cells. %hronic myelogenous leukemia (also called %ML or chronic granulocytic leukemia) is a slowly !rogressing blood and bone marrow disease that usually occurs during or after middle age, and rarely occurs in children. :ormally, the bone marrow makes blood stem cells (immature cells) that de elo! into mature blood cells o er time. A blood stem cell may become a myeloid stem cell or a lym!hoid stem cell. #he lym!hoid stem cell de elo!s into a white blood cell. #he myeloid stem cell de elo!s into one of three ty!es of mature blood cells6
In %ML, too many blood stem cells de elo! into a ty!e of white blood cell called granulocytes. #hese granulocytes are abnormal and do not become healthy white blood cells. #hey may also be called leukemic cells. #he leukemic cells can build u! in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and !latelets. /hen this ha!!ens, infection, anemia, or easy bleeding may occur. #his summary is about chronic myelogenous leukemia. *ee the following 3;B summaries for more information about leukemia6
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Adult Acute Lym!hoblastic Leukemia #reatment %hildhood Acute Lym!hoblastic Leukemia #reatment Adult Acute Myeloid Leukemia #reatment %hildhood Acute Myeloid LeukemiaC8ther Myeloid Malignancies #reatment %hronic Lym!hocytic Leukemia #reatment "airy %ell Leukemia #reatment
3ossible signs of chronic myelogenous leukemia include tiredness, night sweats, and fe er. #hese and other sym!toms may be caused by %ML. 8ther conditions may cause the same sym!toms. A doctor should be consulted if any of the following !roblems occur6
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-eeling ery tired. /eight loss for no known reason. :ight sweats. -e er. 3ain or a feeling of fullness below the ribs on the left side.
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0ed blood cells that carry o1ygen and other materials to all tissues of the body. 3latelets that hel! !re ent bleeding by causing blood clots to form. Aranulocytes (white blood cells) that fight infection and disease
*ometimes %ML does not cause any sym!toms at all. Most !eo!le with %ML ha e a gene mutation (change) called the 3hiladel!hia chromosome. > ery cell in the body contains ;:A (genetic material) that determines how the cell looks and acts. ;:A is contained inside chromosomes. In %ML, !art of the ;:A from one chromosome mo es to another chromosome. #his change is called the D 3hiladel!hia chromosome.E It results in the bone marrow making
flow into a tube. #he blood sam!le is sent to the laboratory and the red blood cells, white blood cells, and !latelets are counted. #he %B% is used to test for, diagnose, and monitor many different conditions. #he 3hiladel!hia chromosome is not !assed from !arent to child. • Blood chemistry studies6 A !rocedure in which a blood sam!le is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ romosome. A !iece of chromosome ' and a !iece of chromosome FF break off and trade !laces. #he or tissue that makes it. • %ytogenetic analysis6 A test in which cells in a sam!le of formed on chromosome FF where the !iece of chromosome ' attaches. #he changed chromosome FF is blood or bone marrow are iewed under a microsco!e to del!hia chromosome. look for certain changes in the chromosomes, such as the 3hiladel!hia chromosome. • Bone marrow as!iration and bio!sy6 #he remo al of bone marrow, blood, and a small !iece of bone by inserting a needle into the hi!bone or breastbone. A !athologist iews the bone marrow, blood, and bone under a microsco!e to look for abnormal cells.
an en7yme, called tyrosine kinase, that causes too many stem cells to de elo! into white blood cells (granulocytes or blasts).
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#ests that e1amine the blood and bone marrow are used to detect (find) and diagnose chronic myelogenous leukemia. #he following tests and !rocedures may be used6
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3hysical e1am and history6 An e1am of the body to check general signs of health, including checking for signs of disease such as an enlarged s!leen. A history of the !atientGs health habits and !ast illnesses and treatments will also be taken. %om!lete blood count (%B%)6 A !rocedure in which a sam!le of blood is drawn and checked for the following6 o #he number of red blood cells, white blood cells, and !latelets. o #he amount of hemoglobin (the !rotein that carries o1ygen) in the red blood cells. o #he !ortion of the sam!le made u! of red blood cells.
Bone marrow as!iration and bio!sy. After a small area of skin is numbed, a Hamshidi needle (a long, hollow needle) is inserted into the !atientGs hi! bone. *am!les of blood, bone, and bone marrow are remo ed for e1amination under a microsco!e. %ertain factors affect !rognosis (chance of reco ery) and treatment o!tions. #he !rognosis (chance of reco ery) and treatment o!tions de!end on the following6
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#he !atientGs age. #he !hase of %ML. #he amount of blasts in the blood or bone marrow. #he si7e of the s!leen at diagnosis. #he !atientGs general health.
After chronic myelogenous leukemia has been diagnosed, tests are done to find out if the cancer has s!read. *taging is the !rocess used to find out how far the cancer has s!read. #here is no standard staging system for chronic myelogenous leukemia (%ML). Instead, the disease is classified by !hase6 chronic !hase, accelerated !hase, or blastic !hase. It is
%om!lete blood count (%B%). Blood is collected by inserting a needle into a ein and allowing the blood to
im!ortant to know the !hase in order to !lan treatment. #he following tests and !rocedures may be used to find out the !hase6
In rela!sed %ML, the number of blast cells increases after a remission. #here are different ty!es of treatment for !atients with chronic myelogenous leukemia. ;ifferent ty!es of treatment are a ailable for !atients with chronic myelogenous leukemia (%ML). *ome treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to hel! im!ro e current treatments or obtain information on new treatments for !atients with cancer. /hen clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. 3atients may want to think about taking !art in a clinical trial. *ome clinical trials are o!en only to !atients who ha e not started treatment. *i1 ty!es of standard treatment are used6 #argeted thera!y #argeted thera!y is a ty!e of treatment that uses drugs or other substances to identify and attack s!ecific cancer cells without harming normal cells. #yrosine kinase inhibitors are targeted thera!y drugs used to treat chronic myelogenous leukemia. A tyrosine kinase inhibitor called imatinib mesylate is used as initial treatment for certain ty!es of chronic myelogenous leukemia in newly diagnosed !atients. It blocks an en7yme called tyrosine kinase that causes stem cells to de elo! into more white blood cells (granulocytes or blasts) than the body needs. Another tyrosine kinase inhibitor called dasatinib is used to treat !atients with certain ty!es of %ML that ha e !rogressed, and is being studied as an initial treatment. %hemothera!y
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%ytogenetic analysis6 A test in which cells in a sam!le of blood or bone marrow are iewed under a microsco!e to look for certain changes in the chromosomes, such as the 3hiladel!hia chromosome. Bone marrow as!iration and bio!sy6 #he remo al of bone marrow, blood, and a small !iece of bone by inserting a needle into the hi!bone or breastbone. A !athologist iews the bone marrow, blood, and bone under a microsco!e to look for abnormal cells.
#here are three ways that cancer s!reads in the body. /hen cancer cells s!read outside the blood, a solid tumor may form. #his !rocess is called metastasis. #he three ways that cancer cells s!read in the body are6
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#hrough the blood. %ancer cells tra el through the blood, in ade solid tissues in the body, such as the brain or heart, and form a solid tumor. #hrough the lym!h system. %ancer cells in ade the lym!h system, tra el through the lym!h essels, and form a solid tumor in other !arts of the body. #hrough solid tissue. %ancer cells that ha e formed a solid tumor s!read to tissues in the surrounding area.
#he new (metastatic) tumor is the same ty!e of cancer as the !rimary cancer. -or e1am!le, if leukemia cells s!read to the brain, the cancer cells in the brain are actually leukemia cells. #he disease is metastatic leukemia, not brain cancer. %hronic myelogenous leukemia has 9 !hases. As the amount of blast cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and !latelets. #his may result in infections, anemia, and easy bleeding, as well as bone !ain and !ain or a feeling of fullness below the ribs on the left side. #he number of blast cells in the blood and bone marrow and the se erity of sym!toms determine the !hase of the disease. %hronic !hase In chronic !hase %ML, fewer than &(. of the cells in the blood and bone marrow are blast cells. Accelerated !hase In accelerated !hase %ML, &(. to &'. of the cells in the blood and bone marrow are blast cells. Blastic !hase
%hemothera!y is a cancer treatment that uses drugs to sto! the growth of cancer cells, either by killing the cells or by sto!!ing them from di iding. /hen chemothera!y is taken by mouth or in4ected into a ein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemothera!y). /hen chemothera!y is !laced directly into the s!inal column, an organ, or a body ca ity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemothera!y). #he way the chemothera!y is gi en de!ends on the ty!e and stage of the cancer being treated. Biologic thera!y Biologic thera!y is a treatment that uses the !atientGs immune system to fight cancer. *ubstances made by the body or made in a laboratory are used to boost, direct, or restore the bodyGs natural defenses against cancer. #his ty!e of cancer treatment is also called biothera!y or immunothera!y. "igh-dose chemothera!y with stem cell trans!lant
In blastic !hase %ML, F(. or more of the cells in the blood or bone marrow are blast cells. /hen tiredness, fe er, and an enlarged s!leen occur during the blastic !hase, it is called blast crisis. 0ela!sed %hronic Myelogenous Leukemia
"igh-dose chemothera!y with stem cell trans!lant is a method of gi ing high doses of chemothera!y and re!lacing blood-forming cells destroyed by the cancer treatment. *tem cells (immature blood cells) are remo ed from the blood or bone marrow of the !atient or a donor and are fro7en and stored. After the chemothera!y is com!leted, the stored stem cells are thawed and
gi en back to the !atient through an infusion. #hese reinfused stem cells grow into (and restore) the bodyGs blood cells. ;onor lym!hocyte infusion (;LI) ;onor lym!hocyte infusion (;LI) is a cancer treatment that may be used after stem cell trans!lant. Lym!hocytes (a ty!e of white blood cell) from the stem cell trans!lant donor are remo ed from the donorGs blood and may be fro7en for storage. #he donorGs lym!hocytes are thawed if they were fro7en and then gi en to the !atient through one or more infusions. #he lym!hocytes see the !atientGs cancer cells as not belonging to the body and attack them. *urgery *!lenectomy is surgery to remo e the s!leen. :ew ty!es of treatment are being tested in clinical trials. Information about clinical trials is a ailable from the :%I /eb site. 3atients may want to think about taking !art in a clinical trial. -or some !atients, taking !art in a clinical trial may be the best treatment choice. %linical trials are !art of the cancer research !rocess. %linical trials are done to find out if new cancer treatments are safe and effecti e or better than the standard treatment. Many of today=s standard treatments for cancer are based on earlier clinical trials. 3atients who take !art in a clinical trial may recei e the standard treatment or be among the first to recei e a new treatment. 3atients who take !art in clinical trials also hel! im!ro e the way cancer will be treated in the future. > en when clinical trials do not lead to effecti e new treatments, they often answer im!ortant $uestions and hel! mo e research forward. 3atients can enter clinical trials before, during, or after starting their cancer treatment. *ome clinical trials only include !atients who ha e not yet recei ed treatment. 8ther trials test treatments for !atients whose cancer has not gotten better. #here are also clinical trials that test new ways to sto! cancer from recurring (coming back) or reduce the side effects of cancer treatment. %linical trials are taking !lace in many !arts of the country. *ee the #reatment 8!tions section that follows for links to current treatment clinical trials. #hese ha e been retrie ed from :%I=s clinical trials database. -ollow-u! tests may be needed. *ome of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be re!eated. *ome tests will be re!eated in order to see how well the treatment is working. ;ecisions about whether to continue, change, or sto! treatment may be based on the results of these tests. #his is sometimes called re-staging.
*ome of the tests will continue to be done from time to time after treatment has ended. #he results of these tests can show if your condition has changed or if the cancer has recurred (come back). #hese tests are sometimes called follow-u! tests or check-u!s. #reatment 8!tions for %hronic Myelogenous Leukemia %hronic 3hase %hronic Myelogenous Leukemia Accelerated 3hase %hronic Myelogenous Leukemia Blastic 3hase %hronic Myelogenous Leukemia 0ela!sed %hronic Myelogenous Leukemia A link to a list of current clinical trials is included for each treatment section. -or some ty!es or stages of cancer, there may not be any trials listed. %heck with your doctor for clinical trials that are not listed here but may be right for you. %hronic 3hase %hronic Myelogenous Leukemia #reatment of chronic !hase chronic myelogenous leukemia may include the following6
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#argeted thera!y with a tyrosine kinase inhibitor. "igh-dose chemothera!y with donor stem cell trans!lant. Biologic thera!y (interferon) with or without chemothera!y. %hemothera!y. *!lenectomy. A clinical trial of lower- dose chemothera!y with donor stem cell trans!lant. A clinical trial of a new treatment.
%heck for ).*. clinical trials from :%I=s 3;B %ancer %linical #rials 0egistry that are now acce!ting !atients with chronic !hase chronic myelogenous leukemia. -or more s!ecific results, refine the search by using other search features, such as the location of the trial, the ty!e of treatment, or the name of the drug. Aeneral information about clinical trials is a ailable from the :%I /eb site. Accelerated 3hase %hronic Myelogenous Leukemia #reatment of accelerated !hase chronic myelogenous leukemia may include the following6
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*tem cell trans!lant. #argeted thera!y with a tyrosine kinase inhibitor. Biologic thera!y (interferon) with or without chemothera!y. "igh-dose chemothera!y. %hemothera!y. #ransfusion thera!y to re!lace red blood cells, !latelets, and sometimes white blood cells, to relie e sym!toms and im!ro e $uality of life. A clinical trial of a new treatment.
%heck for ).*. clinical trials from :%I=s 3;B %ancer %linical #rials 0egistry that are now acce!ting !atients with accelerated !hase chronic myelogenous leukemia. -or more s!ecific results, refine the search by using other search features, such as the location of the trial, the ty!e of treatment, or the name of the drug.
Aeneral information about clinical trials is a ailable from the :%I /eb site. Blastic 3hase %hronic Myelogenous Leukemia #reatment of blastic !hase chronic myelogenous leukemia may include the following6
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#argeted thera!y with a tyrosine kinase inhibitor. %hemothera!y using one or more drugs. "igh-dose chemothera!y. ;onor stem cell trans!lant. %hemothera!y as !alliati e thera!y to relie e sym!toms and im!ro e $uality of life. A clinical trial of a new treatment.
%heck for ).*. clinical trials from :%I=s 3;B %ancer %linical #rials 0egistry that are now acce!ting !atients with blastic !hase chronic myelogenous leukemia. -or more s!ecific results, refine the search by using other search features, such as the location of the trial, the ty!e of treatment, or the name of the drug. Aeneral information about clinical trials is a ailable from the :%I /eb site. 0ela!sed %hronic Myelogenous Leukemia #reatment of rela!sed chronic myelogenous leukemia may include the following6
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#argeted thera!y with a tyrosine kinase inhibitor. ;onor stem cell trans!lant. ;onor lym!hocyte infusion. Biologic thera!y (interferon). A clinical trial of new ty!es or higher doses of targeted thera!y and donor stem cell trans!lant.
%heck for ).*. clinical trials from :%I=s 3;B %ancer %linical #rials 0egistry that are now acce!ting !atients with rela!sing chronic myelogenous leukemia. -or more s!ecific results, refine the search by using other search features, such as the location of the trial, the ty!e of treatment, or the name of the drug. Aeneral information about clinical trials is a ailable from the :%I /eb site.
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8ther genetic abnormalities, e.g., -L#9 mutation, :0A*.
;octors also e1amine the !atient to find out if leukemia cells ha e s!read outside the blood and bone marrow. ;octors may use a chest <-ray and an ultrasound of the abdomen to look at the organs and tissues inside. #hey may also use a test called a lumbar !uncture (s!inal ta!) to find out whether there are leukemia cells in the fluid around the brain and s!inal cord. Treatment options for acute myelogenous leukemia AML can get worse $uickly, so doctors usually begin treatment right away. #o !lan treatment, doctors look at a !atient=s risk factors (also called !rognostic factors). 0isk factors are !atient and disease traits that clinical studies ha e linked to better or worse outcomes from treatment. >1am!les of risk factors are a !atient=s age and subty!e of AML. #o learn more about AML risk factors as well as how treatment o!tions may differ for children or for adults older than age +(, see 0isk -actors for 3lanning #reatment of AML. -or a !atient with AML, the treatment !lan may include6 • %hemothera!y 2 drugs that destroy cancer cells or sto! them from growing (described below). • A bone marrow or cord blood trans!lant (described below). • All-trans retinoic acid (A#0A) if he or she has the subty!e of AML known as !romyelocytic leukemia. • 8ther newer treatments that were recently de elo!ed or are still being studied in clinical trials 2 you can ask your doctor whether any newer treatments may be o!tions for you. /hiche er treatment you and your doctor choose, you may be asked to be !art of a clinical trial. > en standard treatments continue to be studied in clinical trials. #hese studies hel! doctors learn more about which treatments work best for which !atients. Chemotherapy for AML
On this page:
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Acute myelogenous leukemia sym!toms and diagnosis #reatment o!tions for acute myelogenous leukemia %hemothera!y for AML Bone marrow or cord blood trans!lant for AML Making treatment decisions
Acute myelogenous leukemia symptoms and diagnosis AML is the most common ty!e of acute leukemia. More than &&,'(( new cases occur in the )nited *tates each year, mostly in older adults. #he a erage age of a !erson with AML is +, years. -ewer than &(. of !eo!le with AML are children. Acute myelogenous leukemia is also called acute myeloblastic leukemia, acute myeloid leukemia, acute granulocytic leukemia or acute nonlym!hocytic leukemia. Symptoms #he sym!toms of AML are caused by low numbers of healthy blood cells and high numbers of leukemia cells. • /hite blood cells fight infection. Low numbers can lead to fe er and fre$uent infections. • 0ed blood cells carry o1ygen throughout the body. Low numbers can lead to anemia 2 feeling tired or weak, being short of breath and looking !ale. • 3latelets control bleeding. Low numbers can lead to easy bleeding or bruising and tiny red s!ots under the skin (!etechiae). • "igh numbers of leukemia cells may cause !ain in the bones or 4oints. A !erson with AML may feel generally unwell and run-down. "e or she may also ha e other, less common sym!toms. Diagnosis AML is diagnosed when blood and bone marrow sam!les show a large number of leukemia cells. AML has eight subty!es, labeled M( through M5. #he subty!es are based on the ty!e of blood cells affected. #o find out the sub ty!e and how well the leukemia might res!ond to treatment, the sam!les are looked at to find6 • #he number of healthy blood cells. • #he si7e and number of leukemia cells. • #he changes that a!!ear in the chromosomes of the leukemia cells. #his is called cytogenetics.
nduction chemotherapy -or most !atients, the standard first !hase of AML treatment is induction chemothera!y. #he goal of induction chemothera!y is to bring the disease into remission. 0emission is when the !atient=s blood counts return to normal and bone marrow sam!les show no sign of disease (less than ,. of cells are leukemia cells). Induction chemothera!y is ery intense. It usually lasts one week, followed by three or more weeks for the !atient to reco er from the treatment. 8ften two drugs are used6 • %ytarabine (ara-%) • An anthracycline drug such as daunorubicin (;aunomycin) or idarubicin (Idamycin) *ome !atients may also be gi en additional drugs or different drugs. 3atients who ha e the AML subty!e !romyelocytic leukemia also are gi en all-trans retinoic acid (A#0A). If one week of treatment does not bring a remission, treatment may be re!eated once or twice. Induction brings a com!lete remission
in6
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About 5(. to ?(. of adults under age +(. About ,(. of adults o er age +(. More than '(. of children.
If an allogeneic trans!lant may be an o!tion for you, your doctor will do a test to find out your "LA tissue ty!e. @our doctor will also test !ossible donors in your family to find out if they are a suitable match for you. In adults in good health with standard AML and a matched sibling, and allogeneic trans!lant may be considered after remission with induction thera!y. If you do not ha e a suitable donor in your family, your doctor can search the Be #he Match*M 0egistry for an unrelated donor or cord blood unit. #o sa e time, your doctor may check for !otential donors on the registry at the same time he or she is testing for donors in your family. #he closeness of the donor match can affect a !atient=s chances of a good trans!lant outcome. In general, trans!lants using matched sibling donors ha e had the best results. "owe er, outcomes for unrelated donor trans!lants ha e im!ro ed in the last decade. -or some grou!s of !atients, outcomes for sibling donor and unrelated donor trans!lants are similar. $educed%intensity and non%myeloa#lati&e transplants -or some !eo!le with AML, an allogeneic trans!lant may offer the best chance for a long-term remission. "owe er, more than half of !eo!le with AML are o er age +(. Many !eo!le older than age +( are unable to tolerate the intense treatment of a standard trans!lant. 3eo!le with other health !roblems, such as heart disease or organ damage from !re ious chemothera!y, may also be unable to tolerate a standard trans!lant. An allogeneic trans!lant using less intense treatment may be an o!tion for some of these !atients. #his ty!e of trans!lant is called a reduced-intensity trans!lant or nonmyeloablati e trans!lant. Transplant success rates #rans!lants ha e risks of serious com!lications, but a trans!lant offers some !atients the best chance for a long-term remission. If trans!lant is an o!tion for you, your doctor can talk with you about the !ossible risks and benefits of a trans!lant. -or statistics showing !atients= results after trans!lant, see AML #rans!lant 8utcomes. Making treatment decisions AML is an acute disease that can get worse $uickly. Most !atients begin treatment with induction chemothera!y soon after diagnosis. Many !atients reach remission, but rela!se of AML is common. All !atients need a second !hase of treatment to try to !re ent rela!se. #he second !hase of treatment is based on a !atient=s risk factors. (-or more information, see 0isk -actors for 3lanning #reatment of AML.) It is im!ortant to discuss your risk factors and your treatment o!tions with a doctor who is e1!erienced in treating AML.
*uccessful induction chemothera!y destroys most of the leukemia cells, but a few will be left in the body. If these cells are not destroyed, they can cause a rela!se of the disease. More treatment is needed to destroy the remaining leukemia cells. #he ne1t ste! may be consolidation chemothera!y or a trans!lant, de!ending on the treatment !lan. Consolidation chemotherapy #he second !hase of chemothera!y is often called consolidation chemothera!y. #he goal of consolidation chemothera!y is to destroy any remaining leukemia cells. A common treatment is high doses of cytarabine (ara-%) gi en in three or more cycles. ;octors may also use different drugs and schedules. %onsolidation chemothera!y is used to treat many !atients with AML. It is the standard treatment at first remission for adults with low-risk cytogenetic factors (changes in the chromosomes of leukemia cells), es!ecially adults younger than age +(. !one marro" or cord #lood transplant for AML -or some !atients, a bone marrow or cord blood trans!lant may offer the best chance for a long-term remission. A trans!lant is a strong treatment with risks of serious side effects, so it is not used for all !atients with AML. A trans!lant is used when chemothera!y alone is unlikely to !ro ide a long-term remission. Autologous transplant An autologous trans!lant uses blood-forming cells collected from the !atient. If an autologous trans!lant is a treatment o!tion for you, you will ha e blood-forming cells collected from your blood stream. #he cells are usually collected after one or two cycles of consolidation treatment. #he cells are fro7en until you are ready for trans!lant. @ou may recei e an autologous trans!lant soon after your induction thera!y is com!leted, or your cells may be sa ed as a backu! o!tion in case you rela!se after recei ing consolidation chemothera!y. Autologous trans!lants ha e risks of serious side effects, but these risks are lower than for allogeneic trans!lants. "owe er, a !atient has higher risks of a leukemia rela!se after an autologous trans!lant. #his is because leukemia cells may be returned to the !atient along with his or her blood-forming cells. Allogeneic transplant An allogeneic trans!lant re!laces the abnormal cells in a !atient=s bone marrow with healthy blood-forming cells from a family member or unrelated donor or cord blood unit. An allogeneic trans!lant has a higher risk of serious side effects than consolidation chemothera!y or an autologous trans!lant. "owe er, the risk of rela!se is lower after an allogeneic trans!lant. Choosing a donor or cord #lood unit
'lanning for a possi#le transplant
Blood cell de elo!ment. A blood stem cell goes through se eral ste!s to become a red blood cell, !la
All !atients with AML may want to talk with their doctors about including the !ossibility of a trans!lant in their treatment !lan. A trans!lant may be the first choice or it may be a backu! !lan. /hen trans!lant is not the first treatment, early !lanning may allow for more fle1ibility in treatment o!tions and a $uicker trans!lant later, if it is needed. In general, to !re!are for the !ossibility of trans!lant6 • 3atients with AML should be "LA tissue ty!ed at diagnosis. • 3atients should be referred to a trans!lant doctor for consultation at an a!!ro!riate time based on risk factors. • -amily members who might be suitable donors should be tested at the same time as the !atient or soon after. • ;octors can take an early look at !otential unrelated donors and cord blood units on the Be #he Match 0egistry as soon as they know the !atient=s "LA tissue ty!e. #his first look is free of charge. • 3atients who ha e no suitable related donor and few !otential unrelated donors may want to discuss storing their own blood-forming cells for a !ossible autologous trans!lant. #he only !atients who may not benefit from this !lanning are those who would clearly be unable to tolerate e en a reduced-intensity trans!lant. *ome older !atients and !atients who ha e organ damage or other health !roblems may be unable to tolerate a trans!lant. If you want to consider a trans!lant, a trans!lant doctor can e1amine you to see whether a trans!lant is a good o!tion. It is im!ortant to talk about your treatment o!tions with a doctor who is e1!erienced in treating AML. @our doctor can discuss your s!ecific risk factors and treatment o!tions with you. -or more information to hel! you talk to your doctor about whether a trans!lant is an o!tion for you, you can share the referral guidelines (3;-) from the 3hysician 0esources section of this /eb site with your doctor. %hronic myelogenous leukemia is a disease in which the bone marrow makes too many white blood cells. %hronic myelogenous leukemia (also called %ML or chronic granulocytic leukemia) is a slowly !rogressing blood and bone marrow disease that usually occurs during or after middle age, and rarely occurs in children. :ormally, the bone marrow makes blood stem cells (immature cells) that de elo! into mature blood cells o er time. A blood stem cell may become a myeloid stem cell or a lym!hoid stem cell. #he lym!hoid stem cell de elo!s into a white blood cell. #he myeloid stem cell de elo!s into one of three ty!es of mature blood cells6
In %ML, too many blood stem cells de elo! into a ty!e of white blood cell called granulocytes. #hese granulocytes are abnormal and do not become healthy white blood cells. #hey may also be called leukemic cells. #he leukemic cells can build u! in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and !latelets. /hen this ha!!ens, infection, anemia, or easy bleeding may occur. #his summary is about chronic myelogenous leukemia. *ee the following 3;B summaries for more information about leukemia6
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Adult Acute Lym!hoblastic Leukemia #reatment %hildhood Acute Lym!hoblastic Leukemia #reatment Adult Acute Myeloid Leukemia #reatment %hildhood Acute Myeloid LeukemiaC8ther Myeloid Malignancies #reatment %hronic Lym!hocytic Leukemia #reatment "airy %ell Leukemia #reatment
3ossible signs of chronic myelogenous leukemia include tiredness, night sweats, and fe er. #hese and other sym!toms may be caused by %ML. 8ther conditions may cause the same sym!toms. A doctor should be consulted if any of the following !roblems occur6
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-eeling ery tired. /eight loss for no known reason. :ight sweats. -e er. 3ain or a feeling of fullness below the ribs on the left side.
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0ed blood cells that carry o1ygen and other materials to all tissues of the body. 3latelets that hel! !re ent bleeding by causing blood clots to form. Aranulocytes (white blood cells) that fight infection and disease
*ometimes %ML does not cause any sym!toms at all. Most !eo!le with %ML ha e a gene mutation (change) called the 3hiladel!hia chromosome. > ery cell in the body contains ;:A (genetic material) that determines how the cell looks and acts. ;:A is contained inside chromosomes. In %ML, !art of the ;:A from one chromosome mo es to another chromosome. #his change is called the D 3hiladel!hia chromosome.E It results in the bone marrow making
flow into a tube. #he blood sam!le is sent to the laboratory and the red blood cells, white blood cells, and !latelets are counted. #he %B% is used to test for, diagnose, and monitor many different conditions. #he 3hiladel!hia chromosome is not !assed from !arent to child. • Blood chemistry studies6 A !rocedure in which a blood sam!le is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ romosome. A !iece of chromosome ' and a !iece of chromosome FF break off and trade !laces. #he or tissue that makes it. • %ytogenetic analysis6 A test in which cells in a sam!le of formed on chromosome FF where the !iece of chromosome ' attaches. #he changed chromosome FF is blood or bone marrow are iewed under a microsco!e to del!hia chromosome. look for certain changes in the chromosomes, such as the 3hiladel!hia chromosome. • Bone marrow as!iration and bio!sy6 #he remo al of bone marrow, blood, and a small !iece of bone by inserting a needle into the hi!bone or breastbone. A !athologist iews the bone marrow, blood, and bone under a microsco!e to look for abnormal cells.
an en7yme, called tyrosine kinase, that causes too many stem cells to de elo! into white blood cells (granulocytes or blasts).
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#ests that e1amine the blood and bone marrow are used to detect (find) and diagnose chronic myelogenous leukemia. #he following tests and !rocedures may be used6
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3hysical e1am and history6 An e1am of the body to check general signs of health, including checking for signs of disease such as an enlarged s!leen. A history of the !atientGs health habits and !ast illnesses and treatments will also be taken. %om!lete blood count (%B%)6 A !rocedure in which a sam!le of blood is drawn and checked for the following6 o #he number of red blood cells, white blood cells, and !latelets. o #he amount of hemoglobin (the !rotein that carries o1ygen) in the red blood cells. o #he !ortion of the sam!le made u! of red blood cells.
Bone marrow as!iration and bio!sy. After a small area of skin is numbed, a Hamshidi needle (a long, hollow needle) is inserted into the !atientGs hi! bone. *am!les of blood, bone, and bone marrow are remo ed for e1amination under a microsco!e. %ertain factors affect !rognosis (chance of reco ery) and treatment o!tions. #he !rognosis (chance of reco ery) and treatment o!tions de!end on the following6
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#he !atientGs age. #he !hase of %ML. #he amount of blasts in the blood or bone marrow. #he si7e of the s!leen at diagnosis. #he !atientGs general health.
After chronic myelogenous leukemia has been diagnosed, tests are done to find out if the cancer has s!read. *taging is the !rocess used to find out how far the cancer has s!read. #here is no standard staging system for chronic myelogenous leukemia (%ML). Instead, the disease is classified by !hase6 chronic !hase, accelerated !hase, or blastic !hase. It is
%om!lete blood count (%B%). Blood is collected by inserting a needle into a ein and allowing the blood to
im!ortant to know the !hase in order to !lan treatment. #he following tests and !rocedures may be used to find out the !hase6
In rela!sed %ML, the number of blast cells increases after a remission. #here are different ty!es of treatment for !atients with chronic myelogenous leukemia. ;ifferent ty!es of treatment are a ailable for !atients with chronic myelogenous leukemia (%ML). *ome treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to hel! im!ro e current treatments or obtain information on new treatments for !atients with cancer. /hen clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. 3atients may want to think about taking !art in a clinical trial. *ome clinical trials are o!en only to !atients who ha e not started treatment. *i1 ty!es of standard treatment are used6 #argeted thera!y #argeted thera!y is a ty!e of treatment that uses drugs or other substances to identify and attack s!ecific cancer cells without harming normal cells. #yrosine kinase inhibitors are targeted thera!y drugs used to treat chronic myelogenous leukemia. A tyrosine kinase inhibitor called imatinib mesylate is used as initial treatment for certain ty!es of chronic myelogenous leukemia in newly diagnosed !atients. It blocks an en7yme called tyrosine kinase that causes stem cells to de elo! into more white blood cells (granulocytes or blasts) than the body needs. Another tyrosine kinase inhibitor called dasatinib is used to treat !atients with certain ty!es of %ML that ha e !rogressed, and is being studied as an initial treatment. %hemothera!y
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%ytogenetic analysis6 A test in which cells in a sam!le of blood or bone marrow are iewed under a microsco!e to look for certain changes in the chromosomes, such as the 3hiladel!hia chromosome. Bone marrow as!iration and bio!sy6 #he remo al of bone marrow, blood, and a small !iece of bone by inserting a needle into the hi!bone or breastbone. A !athologist iews the bone marrow, blood, and bone under a microsco!e to look for abnormal cells.
#here are three ways that cancer s!reads in the body. /hen cancer cells s!read outside the blood, a solid tumor may form. #his !rocess is called metastasis. #he three ways that cancer cells s!read in the body are6
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#hrough the blood. %ancer cells tra el through the blood, in ade solid tissues in the body, such as the brain or heart, and form a solid tumor. #hrough the lym!h system. %ancer cells in ade the lym!h system, tra el through the lym!h essels, and form a solid tumor in other !arts of the body. #hrough solid tissue. %ancer cells that ha e formed a solid tumor s!read to tissues in the surrounding area.
#he new (metastatic) tumor is the same ty!e of cancer as the !rimary cancer. -or e1am!le, if leukemia cells s!read to the brain, the cancer cells in the brain are actually leukemia cells. #he disease is metastatic leukemia, not brain cancer. %hronic myelogenous leukemia has 9 !hases. As the amount of blast cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and !latelets. #his may result in infections, anemia, and easy bleeding, as well as bone !ain and !ain or a feeling of fullness below the ribs on the left side. #he number of blast cells in the blood and bone marrow and the se erity of sym!toms determine the !hase of the disease. %hronic !hase In chronic !hase %ML, fewer than &(. of the cells in the blood and bone marrow are blast cells. Accelerated !hase In accelerated !hase %ML, &(. to &'. of the cells in the blood and bone marrow are blast cells. Blastic !hase
%hemothera!y is a cancer treatment that uses drugs to sto! the growth of cancer cells, either by killing the cells or by sto!!ing them from di iding. /hen chemothera!y is taken by mouth or in4ected into a ein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemothera!y). /hen chemothera!y is !laced directly into the s!inal column, an organ, or a body ca ity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemothera!y). #he way the chemothera!y is gi en de!ends on the ty!e and stage of the cancer being treated. Biologic thera!y Biologic thera!y is a treatment that uses the !atientGs immune system to fight cancer. *ubstances made by the body or made in a laboratory are used to boost, direct, or restore the bodyGs natural defenses against cancer. #his ty!e of cancer treatment is also called biothera!y or immunothera!y. "igh-dose chemothera!y with stem cell trans!lant
In blastic !hase %ML, F(. or more of the cells in the blood or bone marrow are blast cells. /hen tiredness, fe er, and an enlarged s!leen occur during the blastic !hase, it is called blast crisis. 0ela!sed %hronic Myelogenous Leukemia
"igh-dose chemothera!y with stem cell trans!lant is a method of gi ing high doses of chemothera!y and re!lacing blood-forming cells destroyed by the cancer treatment. *tem cells (immature blood cells) are remo ed from the blood or bone marrow of the !atient or a donor and are fro7en and stored. After the chemothera!y is com!leted, the stored stem cells are thawed and
gi en back to the !atient through an infusion. #hese reinfused stem cells grow into (and restore) the bodyGs blood cells. ;onor lym!hocyte infusion (;LI) ;onor lym!hocyte infusion (;LI) is a cancer treatment that may be used after stem cell trans!lant. Lym!hocytes (a ty!e of white blood cell) from the stem cell trans!lant donor are remo ed from the donorGs blood and may be fro7en for storage. #he donorGs lym!hocytes are thawed if they were fro7en and then gi en to the !atient through one or more infusions. #he lym!hocytes see the !atientGs cancer cells as not belonging to the body and attack them. *urgery *!lenectomy is surgery to remo e the s!leen. :ew ty!es of treatment are being tested in clinical trials. Information about clinical trials is a ailable from the :%I /eb site. 3atients may want to think about taking !art in a clinical trial. -or some !atients, taking !art in a clinical trial may be the best treatment choice. %linical trials are !art of the cancer research !rocess. %linical trials are done to find out if new cancer treatments are safe and effecti e or better than the standard treatment. Many of today=s standard treatments for cancer are based on earlier clinical trials. 3atients who take !art in a clinical trial may recei e the standard treatment or be among the first to recei e a new treatment. 3atients who take !art in clinical trials also hel! im!ro e the way cancer will be treated in the future. > en when clinical trials do not lead to effecti e new treatments, they often answer im!ortant $uestions and hel! mo e research forward. 3atients can enter clinical trials before, during, or after starting their cancer treatment. *ome clinical trials only include !atients who ha e not yet recei ed treatment. 8ther trials test treatments for !atients whose cancer has not gotten better. #here are also clinical trials that test new ways to sto! cancer from recurring (coming back) or reduce the side effects of cancer treatment. %linical trials are taking !lace in many !arts of the country. *ee the #reatment 8!tions section that follows for links to current treatment clinical trials. #hese ha e been retrie ed from :%I=s clinical trials database. -ollow-u! tests may be needed. *ome of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be re!eated. *ome tests will be re!eated in order to see how well the treatment is working. ;ecisions about whether to continue, change, or sto! treatment may be based on the results of these tests. #his is sometimes called re-staging.
*ome of the tests will continue to be done from time to time after treatment has ended. #he results of these tests can show if your condition has changed or if the cancer has recurred (come back). #hese tests are sometimes called follow-u! tests or check-u!s. #reatment 8!tions for %hronic Myelogenous Leukemia %hronic 3hase %hronic Myelogenous Leukemia Accelerated 3hase %hronic Myelogenous Leukemia Blastic 3hase %hronic Myelogenous Leukemia 0ela!sed %hronic Myelogenous Leukemia A link to a list of current clinical trials is included for each treatment section. -or some ty!es or stages of cancer, there may not be any trials listed. %heck with your doctor for clinical trials that are not listed here but may be right for you. %hronic 3hase %hronic Myelogenous Leukemia #reatment of chronic !hase chronic myelogenous leukemia may include the following6
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#argeted thera!y with a tyrosine kinase inhibitor. "igh-dose chemothera!y with donor stem cell trans!lant. Biologic thera!y (interferon) with or without chemothera!y. %hemothera!y. *!lenectomy. A clinical trial of lower- dose chemothera!y with donor stem cell trans!lant. A clinical trial of a new treatment.
%heck for ).*. clinical trials from :%I=s 3;B %ancer %linical #rials 0egistry that are now acce!ting !atients with chronic !hase chronic myelogenous leukemia. -or more s!ecific results, refine the search by using other search features, such as the location of the trial, the ty!e of treatment, or the name of the drug. Aeneral information about clinical trials is a ailable from the :%I /eb site. Accelerated 3hase %hronic Myelogenous Leukemia #reatment of accelerated !hase chronic myelogenous leukemia may include the following6
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*tem cell trans!lant. #argeted thera!y with a tyrosine kinase inhibitor. Biologic thera!y (interferon) with or without chemothera!y. "igh-dose chemothera!y. %hemothera!y. #ransfusion thera!y to re!lace red blood cells, !latelets, and sometimes white blood cells, to relie e sym!toms and im!ro e $uality of life. A clinical trial of a new treatment.
%heck for ).*. clinical trials from :%I=s 3;B %ancer %linical #rials 0egistry that are now acce!ting !atients with accelerated !hase chronic myelogenous leukemia. -or more s!ecific results, refine the search by using other search features, such as the location of the trial, the ty!e of treatment, or the name of the drug.
Aeneral information about clinical trials is a ailable from the :%I /eb site. Blastic 3hase %hronic Myelogenous Leukemia #reatment of blastic !hase chronic myelogenous leukemia may include the following6
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#argeted thera!y with a tyrosine kinase inhibitor. %hemothera!y using one or more drugs. "igh-dose chemothera!y. ;onor stem cell trans!lant. %hemothera!y as !alliati e thera!y to relie e sym!toms and im!ro e $uality of life. A clinical trial of a new treatment.
%heck for ).*. clinical trials from :%I=s 3;B %ancer %linical #rials 0egistry that are now acce!ting !atients with blastic !hase chronic myelogenous leukemia. -or more s!ecific results, refine the search by using other search features, such as the location of the trial, the ty!e of treatment, or the name of the drug. Aeneral information about clinical trials is a ailable from the :%I /eb site. 0ela!sed %hronic Myelogenous Leukemia #reatment of rela!sed chronic myelogenous leukemia may include the following6
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#argeted thera!y with a tyrosine kinase inhibitor. ;onor stem cell trans!lant. ;onor lym!hocyte infusion. Biologic thera!y (interferon). A clinical trial of new ty!es or higher doses of targeted thera!y and donor stem cell trans!lant.
%heck for ).*. clinical trials from :%I=s 3;B %ancer %linical #rials 0egistry that are now acce!ting !atients with rela!sing chronic myelogenous leukemia. -or more s!ecific results, refine the search by using other search features, such as the location of the trial, the ty!e of treatment, or the name of the drug. Aeneral information about clinical trials is a ailable from the :%I /eb site.
