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Acute Leukemia : Treatment
Western Medicine
Chinese Medicine

New and more effective ways of treating leukemia are being discovered annually. Many people with the disease can live for many fruitful years and be cured.

Doctors design a treatment plan to fit each individual's needs. They consider the type of leukemia, how far it has spread, and whether the person has had other cancer before. The person's age, symptoms, and general health are other factors of consideration.

Although acute leukemias show a more aggressive course, they are more often curable than chronic leukemias. The treatment of acute leukemia attempts to kill leukemia cells so they never grow back. Most doctors say that a person is cured if he or she shows no symptoms for five years after treatment. Chronic leukemias are less often curable. The treatment of chronic leukemia attempts to delay the leukemia from getting worse and to manage symptoms.

Treatment of acute leukemia usually involves three stages: 1) induction for remission, 2) post remission, and 3) therapy at the time of relapse. In addition, preventive therapy for leukemia in the brain is given to persons with ALL.

The standard treatments for adult leukemia are chemotherapy and bone marrow transplantation. Radiation and immunotherapy are used in specific types of leukemia. Since the leukemia cells spread throughout the body, surgery cannot cure this disease. However, surgery is done in some cases of lymphocytic leukemia. For example, if the spleen is swollen a doctor may take out the spleen.

Radiation uses X-rays or other high-energy rays to destroy leukemic cells. It is administered either to the whole body or to only one area. Radiation is used for leukemia in the central nervous system (which includes the brain and spinal cord and in the testicles). It is also used for pain caused by spinal cord compression or expansion of bone marrow as a result of the leukemic cells crowding the bone marrow.

Immunotherapy tries to get the body to fight leukemia. It uses protein made by the body or created in a laboratory to boost, direct, or restore the body's defenses against disease. Use of Interferon-alpha helps to strengthen the immune system and may delay the progression of the CML.

Chemotherapy is the most common way to treat leukemia. Chemotherapy means drug therapy in which various drugs are used either in combination or as a single agent. Drugs taken by mouth or injected into a vein enter the bloodstream and kill leukemia cells in most part of the body. This is called systemic chemotherapy.

Rapidly multiplying cells often are more sensitive to the effects of chemotherapy. Most anti-leukemic drugs interact with DNA, the genetic material contained in all human cells. This interaction changes the DNA in such a way that the cancer cells are killed or are prevented from producing more cancer cells. Unfortunately, rapidly dividing normal cells in the body are also affected by these drugs, which can cause serious side effects.

Therapy for induction of remission. Induction refers to initial chemotherapy given to the person with leukemia to induce or produce a complete remission. Complete remission means there are no signs or symptoms of leukemia, and the number of white blood cells and blood cells in the blood and marrow is normal. The success of treatment depends on factors such as the ability to tolerate intensive treatment, the patient's age, and the type of drug regimen.

In AML, the typical induction regimen consists of a combination of anti-cancer drug cytarabine and either one of the anthracyclines: daunorubicin, mitoxanthrone, or idarubicin. This regimen results in 60 to 80% of persons having complete remission.

One exception is the treatment of patients with acute promyelocytic leukemia (APL), a subtype of AML. In APL, a defect in the retinoic acid receptor prevents the normal growth of promyelocytes (precursors to normal myeloid cells). The all-trans-retinoic acid (Tretinoin), a vitamin A derivative, causes leukemia cells to mature and die. This drug is used in addition to the chemotherapy. Another drug, arsenic trioxide, also is available to treat APL.

In ALL, the most commonly used drugs are vincristine, cytarabine, cyclophosphamide, L-asparaginase, and prednisone.

In CML, drugs like hydroxyurea or interferon have been used. A newly approved oral drug, imatinib mesylate (Gleevec) has been successful in promoting remission among the people enrolled in clinical trials. Its effect on long term survival still needs to be seen.

In CLL, chlorambucil, fludarabine, and cyclophosphamide are commonly used in treatment. Chlorambucil produces a 5-year survival in 48% of people affected. With prolonged use, however, the disease becomes resistant to these drugs and progresses.

Post-remission therapy. Once the person with leukemia achieves a complete remission and recovers from the adverse effects of induction therapy, post-remission chemotherapy begins. This therapy tries to kill any remaining leukemia cells. Without further treatment, leukemia will recur in the majority of persons. The same drugs may be administered in a modified schedule or in doses.

In AML, high-dose cytarabine is used in persons less than 55 years old. This results in a long-term disease free survival of 5 years by 15 to 50%.

In ALL, the person continues to receive chemotherapy but in smaller doses. A typical maintenance regimen consists of low-dose oral methotrexate and 6-mercaptopurine. In order to stay in remission it may be continued up to several years.

Therapy at the time of relapse. Relapse refers to the return of leukemia cells, which were once absent, in the bone marrow. Response to further chemotherapy following relapse is usually poorer than the initial response after the induction therapy. For patients with an eligible donor, bone marrow transplantation (BMT) is an option and it may improve chances of survival.

Leukemia in the brain. Certain types of leukemia have a tendency to spread to the nervous system. To prevent or to treat this, doctors may inject a drug into the spinal fluid to destroy any cancer cells. This is known as an intrathecal method of administration. Radiation or high doses of systemic chemotherapy are given at the same time with intrathecal chemotherapy.

Bone marrow transplant (BMT). Bone marrow transplants offer some people with leukemia the best chance for a cure. It is usually performed when the leukemia is in remission but has high risk for relapse ; does not respond fully to the treatment, or relapses after treatment. In order to perform the transplant, higher doses of chemotherapy drugs are given. These high dose drugs effectively destroy the person's leukemia cells. They also kill the normal infection-fighting cells of the bone marrow. To compensate for this destruction, healthy marrow cells are taken from the donor whose tissue type is the same as or almost the same as the person with leukemia. These are infused or transplanted into the person's bloodstream through an intravenous (IV) catheter. It is hoped that the transplanted bone marrow will produce healthy white blood cells on its own.

There are two types of marrow transplants. In the autologous marrow transplantation, the person's own healthy bone marrow that has been saved and "cleansed" of leukemic cells are re-infused to replace marrow that was destroyed. In the allogenic transplantation, marrow from a donor with a match of all six cell-markers, known as human leukocyte antigens (HLA), is used to replace the diseased marrow. The healthy marrow may be obtained from either identical twins (best match), or HLA-matched brother or sister, and more recently, from a person who is not related to the person with leukemia.

Based on most clinical studies, the overall survival rate among the different types of BMT was similar. BMT is successful about 50% of the time when measured two years after the treatment. There was a higher relapse rate in autologous BMT due to the failure of getting rid of all the leukemia cells. However, more persons died in the allogeneic BMT due to the complications.

Complications from treatment

Chemotherapy related complications
Transplant related complications

New treatments:

Scientists and physicians are constantly searching for new and better ways to treat leukemia. Their effort focuses either on improving the efficacy of current drug therapy, reducing its side effects, or trying to attack leukemia cells in new ways. Click here to view some research treatments currently under active investigation and available mostly through clinical trials.


In TCM, the treatment of acute leukemia is based on the type of disharmony pattern.


1. Damp and Heat Type:

Therapeutic aim: Due to an accumulation of damp-heat and toxic pathogens in the whole body, treatment focuses on clearing away heat and dampness evils, eliminating pathogens, and removing toxic substances.

Example of Prescription: Chaiqin Chenling decoction with modification

chai hu chinese torowax root
huang qin baical skullcap root
long dab cao chinese gentian
zhi zi cape jasmine fruit
chen pi dried tangerine peel
fu ling Indian bread
ban xia pinellia tuber
ze xie oriental water plantain rooti
zhu ling chuling
bai zhi large head atractylodes rhizome
lu gen reed rhizome
she she cao herba hedyotis diffusa
qing dai natural indigo

2. Noxious Heat type

Therapeutic aim:
This is caused by excessive noxious heat in the interior, and the disturbance of nutrient qi and blood. Treatment includes clearing away heat evils, removing toxic substances, and clamping down on blood circulation to stop bleeding.
Example of Prescription: Shuiniujiao Dihuang decoction with modification

shui niu jiao buffalo horn
sheng di dried rehmannia root
dan pi tree peony bark
chis hao red peony root
yin hua honeysuckle flower
lian qiao weeping forsythia capsule
zhi zi cape jasmine fruit
sheng shi gao gypsum
bai hua she she cao herba hedyotis diffusae

For delirium caused by intensive heat, Zixue pill, Zhibao pill or Angong Niuhuang pellet is helpful.

3. Accumulated Mass type

Therapeutic aim: This is caused by stagnant phlegm lingering in the interior and blocking the collaterals (meridians). Therefore, treatment includes promoting blood circulation, removing obstruction in meridians, and softening and resolving hard masses.

Example of Prescription: Taohong Siwu decoction with modification

tao ren peach kernel
hong hua safflower
chuan xiong szechwan lovage root
dang gui chinese angelica
di huang rehmannia root
chis hao red peony root
hai zao seaweed
bie jia turtle shell
sheng mu li fresh oyster shell
zhe bei thunberg fritillary bulb
xia ku cao spike of prunella

4. Internal Liver-Wind Stir Up Type

Therapeutic aim: Individuals with this type are in the most critical condition. Emergency treatment includes using aromatic drugs for resuscitation, and suppressing the hyperactive liver to relieve the wind syndrome.

Example of Prescription: Zhengan Xifeng decoction

huai niu xi achyranthes root
sheng long ku unprocessed fossil fragment
sheng bai shao white peony root
tian dong asparagus root
sheng mai ya fresh germinated barley
dai zhe shi ochre
sheng mu li fresh oyster shell
xuan shen figwort root
chuan lian zi szechwan chinaberry fruit
yin chen hao virgate wormwood herb
gui ban tortoise shell
gan cao liquorice root

Additionally, Zixue pill and Angong Niuhuang pellet can be taken with water.


1. Deficiency of Qi and Yin Type

Therapeutic aim: The toxins and heat evils impair heart-qi, and burn primordial yin. As a result, treatment benefits the qi, nourishes the heart, aids the yin and invigorates the kidney.

Example of Prescription: Shenmai, Erzhi plus Dihuang decoction with modification

bei sha shen coastal glehnia root
mai dong dwarf lilyturf tuber
wu wi zi chinese magnoliavine fruit
nu zhen zi glossy privet fruit
han lian cao ecliptai
gou qi chi barbary wolfberry fruit
sheng di dried rehmannia root
dan pi tree peony bark
fu ling indian bread
yi yi ren coix seed
bai ji li puncturevine caltrop fruit
gui ban tortoise shell

For individuals with residual toxic substances:

she she cao herba hedyotis diffusae
ban zhi lian chinese lobelia herb

2. Deficiency of Qi and Blood Type:

Therapeutic aim: This type is caused by the deficiency of both qi and blood. In TCM, the spleen is responsible for the production of blood and qi. The kidney is responsible for storing the essence, which is the source for blood and qi. Therefore, treatment includes replenishing the qi, nourishing the blood, and invigorating the spleen and kidney.

Example of Prescription: Danggui Buxie decoction plus Sijun, Bazhen decoction with modification

huang qi milkvetch root
dang shen pilose asiabell root
dang gui chinese angelica
bai zhi large head atractylodes rhizome
fu ling indian bread
shu di processed rehmannia root
qi zi barbary wolfberry fruit
nu zhen zi glossy privet fruit
e jiao donkey-hide gelatin

For individuals with residual toxic substances and hyperactivity of minute collaterals (meridians):

she she cao herba hedyotis diffusae
xiao ji field thistle herb