Treatment

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A stem cell transplant is an option for some leukemia patients. Doctors obtain stem cells -- blood-forming cells -- by filtering them from the patient's or a donor's bloodstream, then sometimes freezing them. The patient is treated with a high-dose course of chemotherapy, which destroys the cancer cells but also damages the patient's own blood-forming cells. Doctors then administer or transplant the harvested stem cells to the patient to help rebuild his or her immune system. When patients receive their own stem cells back, the procedure is called an autologous stem cell infusion. If the stem cells are not the patient's but a donor's, the procedure is called an allogeneic stem cell transplant.

In some cases, CLL causes a patient's immune system to turn on its own cells. This can result in a range of autoimmune conditions that are often treated with corticosteroids such as prednisone.

Another complication of CLL is Richter syndrome (or Richter transformation). In patients with this condition, CLL undergoes a transformation into a high-grade or aggressive non-Hodgkin's lymphoma (NHL). These patients are treated for NHL.

New, highly sensitive laboratory tests can now probe for minimal residual disease -- the very few leukemia cells that may remain in the body after treatment ends -- in patients with specific types of leukemia. With the information derived from such tests, physicians can chart further treatment options for leukemia patients.

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Investigational Approaches

Researchers are currently developing new agents for cancer treatment. Relying in part on the information that is emerging about the genetic basis of leukemia, investigators are pursuing a variety of strategies to control the disease -- approaches that can kill tumor cells directly, inhibit the body's production of substances that promote their growth, or enhance the immune response against leukemic cells.

• New Chemotherapy Combinations

  Drugs used in chemotherapy work in different ways to stop tumor cells from dividing and to prompt them to undergo programmed cell death, or apoptosis. Physicians usually combine two or more agents in a course of treatment in an effort to kill as many tumor cells as possible. It is not yet known which regimen of combination chemotherapy is most effective for CLL, so clinical trials are underway to compare the effectiveness of various combinations of chemotherapeutic agents.

• Monoclonal Antibodies

  Monoclonal antibodies are genetically engineered proteins designed to target specific proteins called antigens located on the surface of tumor cells. Researchers at Memorial Sloan-Kettering are testing the monoclonal antibody rituximab, in combination with other agents, to determine its most effective use against CLL. Rituximab attaches to the CD20 receptor found on the surface of many types of lymphocytic leukemia cells and in some patients causes the diseased cells to die or to be cleared from the body.

• Engineered T Cells

  T cells are a form of white blood cell. Researchers at Memorial Sloan-Kettering are working to produce T cells that will recognize and attack a patient's cancer cells. To do this, they extract some of the patient's own T cells, introduce a gene that allows these cells to recognize a protein on the surface of the leukemia cells, and grow these cells in culture before giving them back to the patient. The goal is for T cells to be able to recognize the antigens as foreign and multiply in order to attack. Investigators then administer the "engineered" T cells back into the patient so that they will seek out and destroy the cancer cells.