Treatment of acute leukemia

In addition to traditional chemotherapy, the initial treatments for acute leukemia may include combinations of antibodies and chemotherapy or other drugs targeted at the specific characteristics of the disease. We administer the medicines intravenously, subcutaneously, or intramuscularly. Some of the drugs are taken orally in tablet form.

Induction therapy is followed by a low cell count phase of 2 to 5 weeks, during which your immune system is particularly weak and your susceptibility to infections is high. During the low cell count phase, you will often need red blood cell and platelet infusions, as well as other supportive therapies such as antibiotics, painkillers, and anti-nausea medications. During the low cell count phase, you will be either on an inpatient ward or partially in home care in accordance with your condition and our overall assessment of the situation.

In addition to your condition, we assess the effectiveness of treatment, i.e. response to treatment, based on blood tests and bone marrow sample tests. Our goal is remission, i.e. the complete disappearance of leukemia cells. This usually happens 1–3 months after the start of leukemia treatment. For the first time, bone marrow samples are usually examined at two weeks, and subsequent samples are taken after you have recovered from induction therapy, approximately one month after the start of the treatment. If leukemia remission is not achieved with the first induction therapy, we will administer a second induction therapy with different types of drugs. 

For elderly or frail leukemia patients, we can also provide lighter leukemia treatments carried out at the outpatient clinic. In most cases, they do not require similar long-term inpatient care. However, it should be noted that with lighter forms of treatment, it is not possible to achieve a permanent cure for leukemia.

After recovering from the initial treatment for leukemia, i.e. induction therapy, we provide so-called remission stabilization therapies, which aim to achieve long-term remission and cure leukemia permanently. 

We provide stabilization treatments according to a disease-specific treatment regimen and take into account whether your treatment also aims at hematological stem cell transplantation. The exact subtype of leukemia, the treatment regimen chosen and the response to treatment determine the number of stabilization therapies to be administered and the possible need for stem cell transplantation.

We usually give lighter leukemia medication treatments in four-week cycles as long as they are useful to you, i.e. your blood counts remain stable and the leukemia cells are gone.

If you cannot have a stem cell transplant, in acute lymphoblastic leukemia (ALL) we will give you lighter maintenance therapy after the first and second-phase treatments to prevent the leukemia from recurring. Treatments last from diagnosis up to 2.5 years. Maintenance treatment is mainly provided in tablet form. To prevent central nervous system leukemia, patients are also administered small doses of medication into the cerebrospinal fluid. In some subtypes of acute myeloid leukemia (AML), we can provide maintenance therapy for 12–24 months.  

Stem cell transplantation from a healthy donor is, excluding special cases, the most effective treatment for acute leukemia. Stem cell transplantation is performed on Hematology Ward 7B at Meilahti Triangle Hospital. The upper age limit for stem cell transplantation is approximately 70 years.  

In addition to its potential benefits, stem cell transplantation also carries a risk of graft-versus-host disease and serious infections. When making the transfer decision, we make an individual risk assessment for each patient, taking into account the leukemia subtype, treatment response, adverse effects caused by initial treatments, the patient’s general state of health, and finding a suitable sibling or registry donor. Before deciding on the procedure, you will have a discussion with the physician performing the stem cell transplant, based on which we will select the final treatment line.