Treatments

Today, we will be talking about different treatments for leukaemia.

Here are some forms of treatment for Leukaemia :

• Chemotherapy
• Radiotherapy
• Stem cell transplant
• Targeted therapies
• Biological therapies
• Clinical trials

1. Chemotherapy

• Use of drugs to kill cancer, injected into vein/muscle, under skin or taken orally
• Drugs travel by bloodstream to reach cancer cells around body, therefore useful for leukaemia because leukaemia affects blood cells.
• Treatment is given in cycles to allow patients’ body to recover
• Chemo drugs usually do not reach the brain and spinal cord so drugs may have to be injected into cerebrospinal fluid (intrathecal chemo)
• Side effects

                • hair loss

                • loss of appetite

                • mouth sores

2. Radiotherapy

• High energy X-rays are used to kill off cancer cells and shrink cancers(tumours?)
• It is also regarded as local therapy as it only targets cancerous site
• Doctors will mark out the area of your body that is going to undergo radiotherapy. A dosage of radiation will be calculated.
• Radiotherapy is usually given in small doses and is completely painless.
• Side effects experienced are similar to side effects of chemo (nausea, vomiting, hair loss and fatigue)

3. Stem Cell Transplant

• aka Bone Marrow Transplant, is a type of stem cell therapy
• Treatment includes destroying cancerous marrow and then introducing stem cells
• 2 types : allogeneic and autologous
• Allogeneic stem cell transplantation involves the use of donor stem cells along with high intensity chemotherapy to kill all existing ALL (acute lymphocytic leukaemia) cancer cells
• Reduced-Intensity Allogeneic Stem Cell Transplantation used lower doses of chemo compared to a standard allogeneic transplant → does not completely inactivate immune system and thus, treats ALL less aggressively
• A serious risk of allogeneic transplants is Graft-Versus-Host Disease (GVHD). This disease develops if donor’s immune cells attack the patient’s normal tissue. Its effects can range from minor to life threatening.
• Autologous stem cell transplantation involves the use of the patient’s own stem cells. However this procedure is not commonly used as it has a high rate of relapse

4. Targeted Therapy

• Targeted therapy drugs work differently from standard chemotherapy drugs, they target specific parts of cancer cells and have different and less severe side effects
• Some targeted therapy drugs are useful in certain cases of ALL (E.g. leukaemia cells with philadelphia chromosomes)
• Are drugs or substances designed to prevent cancer cells from dividing or directly destroying them
• Goal of targeted therapy is to block spread of disease

5. Biological Therapy

Biological therapy is a treatment that makes use of the body’s immune system to kill cancer cells. It slows/prevents tumour growth and also prevents the spread of cancer. The goal of biological therapy is to induce the body’s immune system to recognize and kill cancer cells.

Biological therapy works 2 ways :

1. Inducing immune system to attack
1. Chemicals that stimulate immune system can be injected into body OR sample of immune system cells can be taken and trained in lab to attack cancer cells before being reintroduced into body
2. Making cancer cells more easily recognizable by body’s immune system
1. Target cancer cells by turning on/off cell signals that help them elude the immune system cells

Tyrosine Kinase Inhibitors (TKIs) are used in biological therapy for Acute Lymphocytic Leukaemia (ALL). They block the action of tyrosine kinases, which cells use to signal each other. These signalling systems cause cells to keep dividing.

Imatinib (Gleevec) is a TKI drug often used to treat Chronic Lymphocytic Leukaemia (CML) and also philadelphia chromosome positive ALL. Studies have shown that chances of going into remission have been increased when Imatinib is used as part of the first phase of treatment (remission induction therapy).

6. Clinical Trials

A clinical trial is a research study that helps to determine whether a new drug or treatment is safe and/or effective. There are several phases of clinical trials and these include :

• Phase 1: Clinical trials that are usually conducted on a small number of healthy volunteers with close safety monitoring. The objective is to determine whether the drug is safe for use in humans and how the drug behaves in the human body. 
• Phase 2: Clinical trials that are conducted in a small number of patients with the illness being researched upon. The objective is to explore the therapeutic efficacy of the drug and to further evaluate its safety. A key objective of this phase is to determine the dose for phase III trial. 
• Phase 3: Clinical trials that are conducted in a larger population of patients. These clinical trials help to demonstrate or confirm the therapeutic efficacy of the drug and to collect more information that will allow the drug to be used safely. These studies are intended to provide an adequate basis for submission to regulatory authorities for product registration.
• Phase 4: Clinical trials that are conducted to gather additional information about a drug's safety, efficacy, and optimal use. They are also sometimes known as post-marketing studies.
^ source gathered from:  http://www.hsa.gov.sg/content/hsa/en/Health_Products_Regulation/Clinical_Trials/Overview/Introduction_to_Clinical_Trials.html

Clinical trials also do come with certain risks and such risks depends on the individual's health and also the type of treatment being studied. For some patients, there may be unpleasant side effects. Most of these side effects are only temporary and ends when treatment is ceased.