Leukemia in Adults – An Introduction, with Dr. Bruno Medeiros

Last Updated: August 20, 2018

Dr. Bruno Medeiros provides an overview about leukemia in adults, including common treatments and recent research.  

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Cancer.Net®: Doctor-Approved Patient Information from ASCO®

Leukemia in Adults: An Introduction

What is Leukemia?

Bruno C. Medeiros, MD:  Leukemias are a cancer of the blood. There are many types of leukemias that physicians and patients deal with.  They can be divided into acute and chronic leukemia.  Acute leukemia is being the ones that come on relatively fast.  Chronic leukemias are the ones that have a slightly more slow pace as we like to say. They can come from different blood cells.  They can be myeloid in lineage where those are cells that usually produce immune fighting cells or form the lymphoid lineage. And so you can have chronic lymphocytic leukemia, chronic myeloid leukemia, acute myeloid leukemia or acute lymphoblastic leukemia. 

I think it’s important to know that there are effective therapeutic options for most if not all patients with leukemia and most patients should expect at least to a certain degree that a curative treatment option should be available to them.

Treatment Options for Leukemia

Dr. Medeiros: As you can imagine with four different subtypes of leukemia, acute, chronic, lymphoid, myeloid, and subtypes within those subtypes there are a number of different treatment options that patients should encounter. I think in brief you can say that most patients with leukemia will be offered some form of chemotherapy.  Surgery is not something commonly used for these patients, radiation therapy is very uncommonly used for these patients.

But within the chemotherapy options there are a number of different subtypes of chemotherapies that can be used, from regimens that contain multiple different drugs, to multi agent regiments all the way to very specialized targeted therapies for very specific subtypes of leukemia.

So the treatment of leukemia can vary quite a lot.  There are patients where the treatment objective is to actually control the disease, minimize side effects and prolong patient’s life. The chances of curing those patients tends to be relatively low, even with extremely aggressive therapies. That is often the case with chronic myeloid leukemia where you take a pill on a daily basis that controls your disease and only a minority of patients are expected to be cured from that therapeutic strategy. 

Other leukemias that use that kind of strategy include, for example, chronic lymphocytic leukemia for older patients where B cell receptor inhibitors are currently being used and are just a pill as well.  You can use multi agent chemotherapy regimens where you use one or more chemotherapy regimens to try to either control disease or in some cases try to cure the patient or you can in specific patients and patients that you feel are deemed for it, use aggressive therapies such as bone marrow transplant in which maximizes the chance of a cure but at the same time is associated with a very high risk procedure.

Latest Research in Acute and Chronic Leukemia

Dr. Medeiros: There’s lots going on.  And that probably stems from some of the improved understanding that we have on the pathophysiology of all of these leukemia’s. And so a number of different efforts have better identified the molecular and genomic lesions that end up leading to the development of acute or chronic leukemia’s and these developments have then allowed physicians and investigators to develop novel targeted agents. 

And so some that could be highlighted I think that have been quite often mentioned on the late press include the use of B cell receptors for chronic lymphocytic leukemia, which likely are going to change the standard of care for patients with chronic lymphocytic leukemia from multi regiment agents that unlikely have the possibility of cures to patients that likely are going to be taking a pill for hopefully a prolonged period of time.  

You have examples as well as in chronic myeloid leukemia where now we have five (inaudible) inhibitors which are just pills that can be taken at home that are extremely effective in controlling the disease in the vast majority of the patients.  And then you have advances in other types of acute leukemias, for example, so acute lymphoblastic leukemia specific subtypes now can be targeted with specific agents.  (Inaudible) like leukemia’s can be targeted with (inaudible) ace inhibitors, such as (inaudible), (inaudible) and agents that target other (inaudible) activating pathways. 

And for the acute myeloid leukemia’s we certainly have been exploring for many years the use of the three inhibitors on the management of these patients and now we have the introduction of novel agents, such as the IDH1 and IDH2 inhibitors without also are very promising or have very promising early clinical trial development.

Where to Get More Information

Dr. Medeiros: I think a great source of information for patients is cancer.net, a site sponsored by ASCO.  I happen to be the editor for the leukemia panel and so I have firsthand understanding of what the content is for that particular website.  And it’s derived to provide information to patients about their disease and what to expect in that particular subtype of leukemia that a patient may have.


[Closing and Credits]

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical OncologyConquerCancerFoundation.org  

Special Thanks:

Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia

Carolyn B. Hendricks, MD, The Cancer for Breast Health

Hasbro Children’s Hospital

Helen F. Graham Cancer Center at Christiana Care Health System

The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University

Video Footage and photography courtesy of:

St. Jude Children’s Research Hospital Biomedical Communications

Moffitt Cancer Center

University Hospitals Case Medical Center Seidman Cancer Center

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