Leukemia

Medications

Chemotherapy is the standard treatment for many types of leukemia. Even when a cure is not possible, chemotherapy may help you live longer and feel better.

Chemotherapy for leukemia is usually a combination of drugs. This is because different drugs attack leukemia cells in different ways. The combination also helps keep the leukemia cells from becoming resistant to any one drug. Other drugs used to treat leukemia help prevent infection and help your body grow new blood cells.

Nausea and vomiting are the most common side effects of chemotherapy for leukemia, and the most feared. But having chemotherapy does not mean that you have to suffer with nausea and vomiting. Your doctor may prescribe medicines to control nausea and vomiting. There are also things you can do at home. For more information on these side effects, see:

Cancer: Controlling nausea and vomiting from chemotherapy.

Medication Choices

Acute leukemia

Different types of leukemia are best treated with different kinds of medicine.

• Acute lymphoblastic leukemia (ALL) drugs include prednisone, vincristine, daunorubicin, L-asparaginase or pegaspargase, methotrexate, and cyclophosphamide. Imatinib (Gleevec) and nelarabine (Arranon) are sometimes used to treat ALL. Dasatinib (Sprycel) is a newer drug for treating some ALL that has not improved with other drugs.
• Acute myelogenous leukemia (AML) drugs include daunorubicin, idarubicin, cytosine arabinoside, and mitoxantrone.⁹ Gemtuzumab (Mylotarg) may be given to people whose AML has relapsed. It helps your body destroy cancer cells.
• Acute promyelocytic leukemia (APL) drugs include all-trans-retinoic acid (ATRA) and chemotherapy with arsenic trioxide, idarubicin, or daunorubicin. ATRA helps control the risk of life-threatening bleeding from disseminated intravascular coagulation (DIC). Later treatment can include ATRA with or without methotrexate and 6-mercaptopurine. Or if a first round of ATRA and chemotherapy does not work, arsenic trioxide may be used.⁹
• To treat leukemia in the brain or prevent it from spreading to the brain and central nervous system, methotrexate and cytarabine/cytosine arabinoside are injected into the spinal canal. This is called intrathecal chemotherapy.

Supportive treatments during cancer treatment include:

• Antibiotics and immunoglobulins help to prevent or fight infections. This is important when you do not have enough normal white blood cells to fight infections on your own.
• Transfusions of red blood cells and platelets.
• Epoetin and hematopoietic stimulants help your body make new blood cells.
• Allopurinol to prevent kidney problems and gout.
• Saline or steroid eyedrops for relief during treatment with cytarabine/cytosine arabinoside.

Chronic leukemia

Treatments for chronic lymphocytic leukemia (CLL) are usually given intravenously for limited periods of time. If there is relapse, medicines are given again. For chronic myelogenous leukemia (CML), medicine is usually taken by mouth for the rest of your life. Treatment choices may include:

• Chemotherapy for chronic leukemia can involve a single drug or a combination of drugs. For example, you may be given a combination of cyclophosphamide, vincristine, and prednisone. Other drug choices include fludarabine, chlorambucil, hydroxyurea (hydroxycarbamide), cytarabine, busulfan, rituximab, and alemtuzumab.
• Allopurinol may be given to prevent kidney problems and gout.
• Dasatinib (Sprycel) blocks the growth of cancer cells. It can be used for CML that has not been helped by imatinib or other drugs.
• Imatinib (Gleevec) blocks the growth of cancer cells. It is often given to people who have CML. Nilotinib (Tasigna) may be given to people who cannot take imatinib.
• Immune globulin (IG) helps prevent infections. It is sometimes used for people with chronic lymphocytic leukemia (CLL), because CLL weakens the immune system. Bendamustine hydrochloride (Treanda) is sometimes given to slow the progression of CLL.

Medication for nausea and vomiting

Nausea and vomiting are common side effects of chemotherapy. These side effects usually are temporary and go away when treatment is stopped. Your doctor will prescribe drugs to help relieve nausea. These may include:

• Aprepitant (Emend), which is used in combination with ondansetron and dexamethasone as part of a 3-day program.
• Dimenhydrinate, such as Dramamine.
• Metoclopramide, such as Reglan and Octamide.
• Phenothiazines, such as promethazine and prochlorperazine.
• Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril or Sancuso), or dolasetron (Anzemet). These drugs work best when they are combined with corticosteroids such as dexamethasone.

What To Think About

There are a lot of clinical trials of new drugs for leukemia. These trials have made it possible for many people with leukemia to live longer. Ask your doctor whether you are a candidate for participation in a clinical trial. For more information, see www.cancer.gov/clinical_trials/ or http://clinicaltrials.gov.

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Author:	Bets Davis, MFA	Last Updated: November 26, 2008
Medical Review:	Anne C. Poinier, MD - Internal Medicine Brian Leber, MDCM, FRCPC - Hematology
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