Leukemia is a commonly occurring blood cancer that primarily affects children, but adults and elders are also at significant risk. It can affect daily life by weakening the immune system and affecting energy levels, blood clotting, and overall health.
To treat leukemia, several options are available based on the types and severity of the condition. However, chemotherapy for leukemia is the primary possible treatment that can be provided alone or in combination with other treatments.
What is Leukemia?
Leukemia is a complex blood cancer that occurs in the bone marrow, a blood-forming tissue. In leukemia, abnormal white blood cells grow uncontrollably, crowding out healthy cells and impairing the body’s ability to fight infection, control bleeding, and transport oxygen.
Leukemia is broadly classified based on:
Speed of Progression
- Acute Leukemia: Develops rapidly and requires immediate treatment
- Chronic Leukemia: Progresses slowly and may remain asymptomatic in early stages
Type of Blood Cell Affected
- Lymphocytic Leukemia: Affects lymphoid cells, which are part of the immune system
- Myeloid Leukemia: Affects myeloid cells, which give rise to red cells, white cells, and platelets
Most Common Types of Leukemia
- Acute Lymphoblastic Leukemia (ALL): Most common in children; progresses rapidly
- Acute Myeloid Leukemia (AML): More frequent in adults; aggressive and fast-growing
- Chronic Lymphocytic Leukemia (CLL): Common in older adults; slow progression
- Chronic Myeloid Leukemia (CML): Associated with the Philadelphia chromosome; can often be managed with targeted therapy
Less Common Types of Leukemia
- Hairy Cell Leukemia (HCL): A rare, slow-growing B-cell leukemia with “hair-like” projections on cells.
- Juvenile Myelomonocytic Leukemia (JMML): A rare leukemia in young children with mixed features of myeloid and lymphoid cells.
- Large Granular Lymphocytic Leukemia (LGL): A chronic leukemia involving large lymphocytes, often T-cells or NK cells.
- Mixed Phenotype Acute Leukemia (MPAL): A rare form that shows both myeloid and lymphoid characteristics.
- Acute Promyelocytic Leukemia (APL): A distinct subtype of AML with a specific genetic mutation; requires unique treatment protocols.
All of these leukemia types can be treated with chemotherapy, either alone or alongside therapies like targeted treatment, radiation, or stem cell transplant, depending on the specific diagnosis and risk profile.
How does Chemotherapy Treat Leukemia?
Chemotherapy uses powerful anti-cancer medications to destroy leukemia cells or prevent them from multiplying. These drugs circulate through the bloodstream, allowing them to reach cancer cells throughout the body, including those that may have spread beyond the bone marrow.
Chemotherapy affects leukemia cells in multiple ways, depending on the specific drug being used. Chemotherapy may:
- Alter the DNA of cancer cells, reducing their ability to grow and divide
- Damage cellular structures, interfering with the cancer cell’s function
- Trigger cell death (apoptosis) in rapidly dividing leukemia cells
- Prevent cancer cells from repairing their damaged DNA, leading to cell breakdown
The chemotherapy can be provided either through oral chemotherapy (pills or capsules), Intravenous (IV) chemotherapy, or Intrathecal chemotherapy (injected into the cerebrospinal fluid for cases involving the central nervous system).
What are the Phases of Chemotherapy for Leukemia?
The following are the phases of chemotherapy for leukemia, planned according to the patient’s condition and leukemia type.
- Induction Therapy: The first step used to bring about remission is to kill as many leukemia cells as possible and restore healthy blood counts. It typically involves a combination of chemotherapy drugs given over 4–6 weeks. Patients usually receive chemo for 5–7 days. followed by a recovery period before the next cycle, as multiple cycles are often required to eliminate detectable leukemia cells from blood and bone marrow.
- Post-Remission (Consolidation/Intensification) Therapy: It targets residual leukemia cancer cells not visible in tests but still present in the body. Without this phase, leukemia is more likely to relapse. It involves high-dose chemotherapy or, in some cases, a stem cell transplant.
- Maintenance Therapy: A less intensive phase used primarily for ALL (Acute Lymphoblastic Leukemia) and APL (Acute Promyelocytic Leukemia). It aims to prevent relapse by keeping any remaining cancer cells under control. It can last up to 2 years after post-remission therapy ends.
Central Nervous System (CNS)-Directed Therapy
ALL can spread to the brain and spinal cord even when not initially detectable. Hence, CNS prophylaxis is routinely given during all treatment phases for ALL, as this may occur in only 3% to 7% of ALL cases.
Types of CNS-Directed Therapy:
- Intrathecal Chemotherapy: Drugs are injected directly into the spinal canal
- Systemic Chemotherapy: Given through a vein but designed to reach the CNS
- Cranial Irradiation: Radiation to the brain (used selectively, mostly in high-risk or T-cell ALL cases)
Note: CNS involvement at diagnosis occurs in only 3–7% of ALL patients, but CNS prophylaxis is provided universally to reduce relapse risk.
Precautions During Chemotherapy for Leukemia
Follow these precautions while undergoing chemotherapy for leukemia:
- Maintain hygienic conditions; keep surroundings clean
- Avoid crowded places and contact with sick individuals
- Avoid alcohol, smoking, and raw or undercooked meats
- Get plenty of rest and engage in light activity if approved
- Use gentle skincare products and protect your skin from the sun
- Take all medications strictly as prescribed by your doctor
- Report fever, unusual bleeding, or any new symptoms immediately
- Attend all scheduled follow-up visits and lab tests without delay
What are the Side Effects of Chemotherapy for Leukemia?
Chemotherapy can affect healthy cells, leading to side effects such as
- Fatigue and weakness
- Hair loss
- Nausea and vomiting
- Mouth sores
- Increased risk of infections
- Bleeding or bruising easily
- Loss of appetite or weight loss
- Fertility changes
- Risk of secondary cancers (in rare cases)
Most side effects are manageable and temporary. Supportive care and medications are provided alongside treatment to help reduce discomfort.
Key Takeaways
Chemotherapy for leukemia is considered the primary and most effective treatment approach. Treatment is typically delivered in phases—induction, consolidation, and, in some cases, maintenance—to ensure the complete elimination of leukemia cells and reduce the risk of relapse. Depending on the specific case, chemotherapy may be combined with other therapies such as stem cell transplantation or targeted treatments. With timely and appropriate treatment, many patients achieve remission and significantly improved outcomes.
