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Most patients with leukemia are treated with chemotherapy. Some also may have radiation therapy and/or bone marrow transplantation (BMT) or biological therapy. In some cases, surgery to remove the spleen (an operation called a splenectomy) may be part of the treatment plan.

Chemotherapy is the use of drugs to kill cancer cells. Depending on the type of leukemia, patients may receive a single drug or a combination of two or more drugs.

Some anticancer drugs can be taken by mouth. Most are given by IV injection (injected into a vein). Often, patients who need to have many IV treatments receive the drugs through a catheter. One end of this thin, flexible tube is placed in a large vein, often in the upper chest.

Drugs are injected into the catheter, rather than directly into a vein, to avoid the discomfort of repeated injections and injury to the skin.

Anticancer drugs given by IV injection or taken by mouth enter the bloodstream and affect leukemia cells in most parts of the body. However, the drugs often do not reach cells in the central nervous system because they are stopped by the blood-brain barrier. This protective barrier is formed by a network of blood vessels that filter blood going to the brain and spinal cord. To reach leukemia cells in the central nervous system, doctors use intrathecal chemotherapy. In this type of treatment, anticancer drugs are injected directly into the cerebrospinal fluid.

Intrathecal chemotherapy can be given in two ways. Some patients receive the drugs by injection into the lower part of the spinal column. Others, especially children, receive intrathecal chemotherapy through a special type of catheter called an Ommaya reservoir. This device is placed under the scalp, where it provides a pathway to the cerebrospinal fluid. Injecting anticancer drugs into the reservoir instead of into the spinal column can make intrathecal chemotherapy easier and more comfortable for the patient.

Chemotherapy is given in cycles; a treatment period followed by a recovery period, then another treatment period, and so on. In some cases, the patient has chemotherapy as an outpatient at the hospital, at the doctor's office, or at home. However, depending on which drugs are given and the patient's general health, a hospital stay may be necessary.

Here are some questions patients and their families may want to ask the doctor before starting chemotherapy:

What drugs will be used?
When will the treatments begin? How often will they be given? When will they end?
Will I have to stay in the hospital?
How will we know whether the drugs are working?
What side effects occur during treatment? How long do the side effects last? What can be done to manage them?
Can these drugs cause side effects later on?
Radiation therapy is used along with chemotherapy for some kinds of leukemia. Radiation therapy (also called radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. The radiation comes from a large machine.

Radiation therapy for leukemia may be given in two ways. For some patients, the doctor may direct the radiation to one area of the body where there is a collection of leukemia cells, such as the spleen or testicles. Other patients may receive radiation that is directed to the whole body. This type of radiation therapy, called total-body irradiation, usually is given before a bone marrow transplant.

Here are some questions patients and their families may want to ask the doctor before having radiation therapy:

When will the treatments begin? How often are they given? When will they end?
Can normal activities be continued?
How will we know if the treatment is working?
What side effects can be expected? How long will they last? What can be done about them?
Can radiation therapy cause side effects later on?
Antibody therapy is a leukemia treatment using molecularly targeted drugs, called monoclonal antibodies, that can directly kill specific tumor cells or stimulate the immune system to kill cancer cells. It is generally less toxic than chemotherapy and radiation.

Bone marrow transplantation also may be used for some patients. The patient's leukemia-producing bone marrow is destroyed by high doses of drugs and radiation and is then replaced by health bone marrow. The healthy bone marrow may come from a donor, or it may be marrow that has been removed from the patient and stored before the high-dose treatment. If the patient's own bone marrow is used, it may first be treated outside the body to remove leukemia cells. Patients who have a bone marrow transplant usually stay in the hospital for several weeks. Until the transplanted bone marrow begins to produce enough white blood cells, patients have to be carefully protected from infection.

Here are some questions patients and their families may want to ask the doctor about bone marrow transplantation:

What are the benefits of this treatment?
What are the risks and side effects? What can be done about them?
How long will I be in the hospital? What care will be needed after I leave the hospital?
What changes in normal activities will be necessary?
How will we know if the treatment is working?
Biological therapy involves treatment with substances that affect the immune system's response to cancer. Interferon is a form of biological therapy that is used against some types of leukemia.
Here are some questions patients and their families may want to ask the doctor before starting biological therapy:

What kind of treatment will be used?
What side effects can be expected? How long do the side effects last? What can be done to manage them?
How will we know if the treatment is working?
Clinical trials help doctors find out whether a new treatment is both safe and effective. They also help doctors answer questions about how the treatment works and what side effects it causes.

Doctors are studying new treatments for all types of leukemia. They are working on new drugs, new drug combinations and new schedules of chemotherapy. They also are studying ways to improve bone marrow transplantation.

Many trials involve various forms of biological therapy. Interleukins and colony stimulating factors are forms of biological therapy being studied to treat leukemia. Doctors are also studying ways to use monoclonal antibodies in the treatment of leukemia. Often biological therapy is combined with chemotherapy or bone marrow transplantation.