Leukemia is a cancer of the blood cells and bone marrow. Depending on which cells are involved and how fast it grows, leukemia can be classified into different types, and treatment options are based on the type of leukemia you have.

Here are the treatment options for people with leukemia.

Treatment can depend on a variety of things, including your age and your general health. It also depends on what type of leukemia you have and the stage of your leukemia.

The four main types of leukemia are:

Here’s more information about the stages of some types of leukemia.

Your hematologist, oncologist, and treatment team will explain your options with you and decide upon the best treatment plan for you and your situation.

Your treatment options will depend on your individual factors. Common treatment options include:

  • bone marrow transplant
  • chemotherapy
  • radiation
  • targeted therapy
  • immunotherapy
  • clinical trials

You may have a combination of one or more of these treatments. Here’s more information about these leukemia treatment options:

Also called bone marrow transplant, HPSCT involves the use of healthy stem cells to help destroy cancer cells and help produce more healthy stem cells.

What is HPSCT?

A bone marrow transplant, or HPSCT, is the process of replacing blood cells in the body. To do this, healthy blood stem cells are injected into the body. These stem cells travel to the bone marrow where they replace the current stem cells called hematopoietic stem cells. These hematopoietic stem cells can only make exact copies of themselves, and in people with leukemia, these cells are part of the problem because they are unhealthy.

When the new blood stem cells reach the bone marrow, they reproduce healthy blood cells. When enough healthy blood cells are produced, they begin to replace the unhealthy blood cells that are causing leukemia.

HPSCT may be performed after something called consolidation therapy — the process of killing unhealthy blood cells — which may be done by radiation therapy or chemotherapy. HPSCT may also be done before consolidation therapy.

There are two main types of bone marrow transplant:

Autologous transplants

Autologous transplants use an individual’s own stem cells. These stem cells must be harvested before starting other treatments, like chemotherapy, that may affect these cells. An individual must also have healthy bone marrow. In this type of HPSCT, an individual’s stem cells are harvested, treated, and returned to the body.

Allogeneic transplants

Allogeneic transplants use donated stem cells. The stem cell donor must be a close genetic match. A donor who is a relative and a close match to the person who has leukemia has the best success rate. Non-relative donors are usually found from a donor registry.

How is it done?

Receiving stem cells is similar to receiving a blood transfusion. A needle may be inserted into a large vein in your arm, or you may have a central venous catheter placed in a blood vessel in the right side of your chest and the stems cells will flow into your heart.

You may already have a central venous catheter prior to HPSCT because you may also receive blood transfusions, medications, nutrition, and other treatments through this port.

Harvesting or collecting stems cells is generally done in one of two ways. Stem cells may be removed from the hip bones. You are sedated so you don’t feel discomfort or pain. A needle is inserted into each hip bone, and the stem cells are removed.

Stem cells may also be collected in a process called leukapheresis. During leukapheresis, you’re given five shots of a medication that helps stem cells move from bone marrow into the blood. Blood is then drawn through an IV. Using a machine, stem cells are separated from the blood.

Read this for more detailed information about HPSCT.

Which types of leukemia may be treated with it?

All four main types of leukemia may be treated with HPSCT.

What are the side effects and risks?

Complications may occur, but not everyone will experience them. Complications may include:

Chemotherapy is a main treatment for many different cancers, including leukemia.

What is chemotherapy?

Chemotherapy uses strong drugs or chemicals, sometimes in combination, to damage or kill cancer cells. This treatment is systemic, which means chemotherapy drugs attack cancer cells, which tend to be fast-growing. However, these drugs can also affect healthy cells.

How is it given?

Chemotherapy can be given orally as a pill, capsule, or liquid, but most of the time, the drugs are given intravenously, through a catheter or central line. This is a port-like device attached to one of your veins that allows you to receive intravenous drugs.

It is often given on a schedule, with certain weeks including treatment days and other weeks with no treatment days. The dosing schedule will vary, depending on your type of leukemia and the type of chemotherapy used.

Which types of leukemia may be treated with this?

All four main types of leukemia may be treated with chemotherapy. In ALL, AML, and CLL, it’s the first and main treatment. For CML, targeted therapies are typically used first, followed by chemotherapy.

What are the side effects and risks?

As with any medical treatment, there are side effects with chemotherapy depending on the drug used, dosage, and how long you take it.

Side effects may include:

  • diarrhea/constipation
  • easy bruising/bleeding
  • fatigue
  • hair loss
  • loss of appetite
  • mouth sores
  • nausea/vomiting

Not everyone will have all of the side effects.

Some chemotherapy drugs can have long-term effects, like and increased risk of other cancers and heart issues. Talk with your doctor about risks of chemotherapy drugs, both short- and long-term.

Read this for more about these potential side effects.

Radiation is not used as much as chemotherapy, but it may be helpful in relieving various associated symptoms.

What is radiation therapy?

Radiation therapy uses high doses of radiation aimed at a concentrated spot to kill cancer cells and shrink tumors.

How is it administered?

Radiation therapy involves sessions several times a week for ­usually between 1 to 10 weeks. During the sessions, radiation is aimed at a specific area of your body. Sessions last between 10 and 30 minutes.

Read this for more information about how radiation therapy is administered.

Which types of leukemia may be treated with this?

Radiation isn’t often used to treat leukemias, although it may be used for CLL. Radiation can shrink swollen lymph nodes and help reduce any associated pain.

What are the side effects and risks?

Radiation can cause different side effects depending on what area of the body it’s treating.

Read more about the side effects and risks of radiation therapy.

Immunotherapy may also be used to treat certain types of leukemia.

What is immunotherapy?

Immunotherapy is a treatment that helps your immune system fight off infections and diseases.

Types of immunotherapy for leukemia include:

  • Monoclonal antibody therapy. This therapy helps your body produce antibodies that typically fight infection.
  • CAR T-cell therapy. This is a newer type of therapy that uses your body’s own T cells, a type of white blood cell, to help fight leukemia.
  • Donor lymphocyte infusion. Often used in conjunction with stem cell therapy, this therapy involves using donor white blood cells.
  • Interferon. This therapy uses artifically made proteins to help stimulate your body to fight leukemia.

There are currently 10 immunotherapy drugs that are FDA-approved for the treatment of leukemia.

Read this article for more information about immunotherapy for leukemia.

How it is administered

Immunotherapy may be given in a few different ways, including:

  • intravenous (through a vein)
  • oral
  • topical
  • intravesical (into the bladder)

Depending on the type of cancer, the administration route can vary. For leukemia, it’s either intravenous or oral.

Types of leukemia that may be treated with this

All four main types of leukemia may be treated with immunotherapy.

Side effects/risks

Side effects depend on which immunotherapy treatment you have, as well as the dose.

Possible side effects of immunotherapy include:

  • pain
  • swelling
  • itchiness
  • flu-like symptoms
  • diarrhea
  • heart palpitations
  • low or high blood pressure

Ask your doctor about side effects of your specific immunotherapy drug.

Targeted therapies are similar to chemotherapy in their end goal, but how they work is different.

What this treatment is

Like chemotherapy, targeted therapies use drugs to promote cell death and stop cancer from multiplying and spreading. However, unlike chemotherapy, which affects all kinds of cells — even healthy ones — targeted therapies focus on specific molecular and cellular changes and proteins unique to leukemia.

The hope is that healthy cells are not as affected, focusing just on cancer cells and minimizing side effects.

How it is administered

Targeted therapy may be given as an oral medication or given intravenously.

Types of leukemia that may be treated with this

All types of leukemia can be treated with different types of targeted therapy drugs.

Side effects/risks

There is still the risk of side effects with targeted therapies. Some people get some, some people get none. It can depend on the specific drug you are taking and what it targets.

Talk with your treatment team about potential side effects and what you might expect.

Side effects of targeted therapies may include:

  • skin changes
  • high blood pressure
  • blood clotting problems
  • heart damage
  • autoimmune reactions
  • nausea and/or vomiting
  • diarrhea and/or constipation
  • mouth sores
  • hair loss

Newer research has focused on engineered immune cells as a class of cancer drugs.

What this treatment is

This treatment is something called adoptive cell transfer (ACT). It’s when the patient’s own immune cells are used to fight cancer. There are several kinds, but the most developed one is called CAR T-cell therapy. CAR T-cell therapy uses engineered T cells that recognize B-cell cancers and attack them.

How it is administered

Most of its use in leukemia is currently restricted to clinical trials. This therapy is generally administered intravenously.

Types of leukemia that may be treated with this

CAR T-cell therapy is approved for patients up to age 25 with relapsed acute lymphoblastic leukemia or ALL that doesn’t respond to any other treatment. There are currently clinical trials for other types of leukemia and blood cancers.

Side effects/risks

Patients getting CAR T-cell therapy stay in the hospital for several weeks for monitoring and management of any side effects. Possible side effects may include:

  • Cytokine release syndrome. This is an inflammatory condition that can cause flu-like symptoms, trouble breathing, confusion, and low blood pressure.
  • Neurological issues. Some people have confusion, trouble understanding language and speaking, or stupor.

For some people, participating in a clinical trial may be a helpful part of their treatment.

What are clinical trials

Clinical trials are research studies involving humans. They are the main way that scientists find out if a treatment is safe and effective.

How to find clinical trials

Clinical trials often have inclusion criteria; this means that participants have to meet certain criteria to even be considered. You can search the global database for clinical trials.

Your treatment team will also know about any clinical trials you may be eligible to participate in. Oncologists are kept up to date about clinical trials within their specialty.

Risks/benefits of clinical trials

Clinical trials have risks and benefits, just like any kind of cancer treatment. Learning about possible pros and cons can help you make an informed decision about whether to participate in a trial.

Risks may include:

  • unknown side effects
  • ineffective treatment
  • no choice in treatment options
  • possibly not covered by insurance

Benefits may include:

  • helping others with the same disease
  • treatment that works better than the current standard of care
  • more visits with your treatment team for monitoring

There are many different kinds of treatments for leukemia, and treatment depends on the type of leukemia you have.

Talk with your doctor about your treatment options and how they may affect your general health. Knowing more about your options can help you make an informed decision and be an active part of your healthcare team.