Treatment of acute lymphoblastic leukemia in Israel should be started as early as possible after diagnosis. The basic method - chemotherapy. Also used for the treatment of the following methods: radiation therapy, stem cell transplantation, and bone marrow, steroids, growth factors. The choice of treatment methods will affect age, subtype of leukemia, the patient's general condition and fitness. Another treatment option - is to participate in clinical trials.
Assuta Hospital offers some of the best conditions in Israel for the treatment of this disease.
Chemotherapy in the treatment of acute lymphoblastic leukemia in Israel
When used antineoplastic chemotherapy (cytostatic) drugs for destroying cancer cells. Drugs enter directly into the bloodstream by a central catheter which is implanted under local or general anesthesia. Analog may be portacath - portkat. This device, which is placed under the skin in the chest area using local anesthesia.
Chemotherapy is carried out in the clinic. This is due to the following reasons:
- Under the influence of chemotherapy drugs a person may feel ill for some time.
- Perhaps the development of side effects, which will help control hospital staff.
- It requires intravenous antibiotics in the treatment of infections.
Detailed plan of treatment for acute lymphoblastic leukemia depends on several factors, but usually it is separated into phases. When ALL is assigned to several different chemotherapeutic agents. Treatment lasts several days, followed by a break and then resumes lymphoblastic leukemia treatment.
Achieving remission in ALL
The main objective of this phase of treatment - to achieve remission, that is, to achieve the destruction of malignant cells.
The patient is prescribed a few of chemotherapy and steroids. But these methods experience side effects. There is a possibility of bleeding and infection. To avoid this, doctors prescribe antibiotics and spend getransfuzii (blood transfusions). Most people need to stay in hospital until they receive treatment and recover. The clinic Assuta, doctors and nurses will be able to control the side effects of therapy.
Leukemic cells secrete uric acid, when die. High levels of this substance can cause kidney damage. Therefore, a reception of such drugs or as allopurinol rasburikaza to control the concentration of uric acid.
Consolidation in the treatment of acute lymphoblastic leukemia in Israel
This is the second phase of chemotherapy, leukemia when reached remission. There are different types of treatment. This may be one of high doses of cytotoxic drugs, which was used during the induction phase. Maybe sometimes outpatient holding therapy. Either performed intensive treatment including stem cell transplantation.
Preventing the proliferation of leukemia in the brain and cerebrospinal fluid
Abnormal cells are able to hit the brain and spinal cord. The introduction of chemicals into the vein does not reach them in these areas. Therefore, cytostatic medications are administered in CSF (cerebrospinal fluid). Liquor circulates around the spinal cord and brain. This is called - intrathecal chemotherapy, the drug enters the intrathecal space of the brain. Doctors in chemotherapy is typically used as methotrexate. Headache and nausea - side effects of this treatment.
More can be administered a prophylactic brain irradiation to destroy any leukemia cells.
Supportive treatment of acute lymphoblastic leukemia in Israel
At this stage, all the preparations are administered in smaller doses, possibly in addition outpatient treatment. The entire course of therapy for acute lymphoblastic leukemia takes about two years.
Chemotherapy in ALL
When the disease is assigned two or more cytostatics. Among them say:
- Cytarabine (Ara-C).
- Doxorubicin (adriamycin).
- Mercaptopurine (6-MP).
- Teniposide (Vumon).
During the induction phase mainly assigned combination preparations. For example, vincristine, steroid (prednisolone) and agents, anthracyclines - daunorubicin or doxorubicin. Perhaps - asparaginase.
If the Philadelphia chromosome was discovered, it recommended targeted therapy - the drug imatinib (Glivec) and chemotherapy.
The consolidation phase the patient receives more cytostatic agents. A typical combination includes doxorubicin, methotrexate, asparaginase and cytarabine, possible radiotherapy.
At the stage of maintenance treatment of lymphoblastic leukemia in Israel, doctors may suggest methotrexate, vincristine, prednisone and mercaptopurine.
Cytostatic agents affect people in different ways. Not all there are the same side effects. Doctors can not predict how the body will react. Note the following common undesirable effects:
- Lack of blood cells.
- Nausea, diarrhea.
- Loss of fertility.
All drugs used to treat cancer, provoke a decline in the level of blood cells. A few weeks after the end of chemotherapy will experience a high level of infection. At this time, the majority of people in need of intravenous antibiotic therapy for the treatment of infection.
About a month later, it increases the likelihood of a low level of red blood cells (anemia), in which case you may need blood transfusions for their replenishment. If you do not have enough platelets, then carried them transfusion of blood.
Cytotoxic drugs will lead to hair loss - on the head and body. But after the treatment the hair grows back.
Unfortunately, chemotherapy for the treatment of acute lymphoblastic leukemia in adults leads to infertility - temporary or permanent. It is possible to freeze sperm and ova. However, the preservation of eggs is not always possible, because treatment should be started as soon as possible, while collecting procedure takes several weeks. It is important with this issue immediately consult a doctor.
Preparations for monitoring the effects of treatment of lymphoblastic leukemia
Chemotherapy causes side effects that need to be controlled. The substances are released by the destruction of the leukemic cells may harm the liver and kidney health. This is called tumor lysis syndrome. For its control used a drug called allopurinol, which helps the body to process waste dead leukemic cells. If very high level of leukocytes or present T-ALL cells, can be assigned to the drug intravenously - rasburikaza, tablets - allopurinol.
Cytostatic agents increase the risk of infection. In order to prevent infection from the environment of natural bacteria in the intestines, intestinal appoint sterilizers. May require tablets and mouthwashes, to prevent the occurrence of oral infections, such as thrush.
Steroids in the treatment of acute lymphoblastic leukemia in Israel
Steroids - are substances which are synthesized naturally in the human body. Artificial steroids are used by doctors as a drug. Treatment lymphoblastic leukemia efficiently when combined with chemotherapy taking steroids.
The formulations can be administered in tablets or injections. Prednisone and dexamethasone - the most common steroid drugs.
Since the steroid does not continue for a long time without interruption, severe side effects were observed. But may develop some undesirable consequences:
- increased appetite;
- increasing energy level, enhancing the state of wakefulness;
- increased risk of infection;
- mood swings.
If steroids are taking a certain time, they can cause water retention in the body. Swollen hands, feet, there is an increase in weight.
Steroids irritate the stomach lining. They need to take into mealtime. But during chemotherapy is not always possible to eat. Therefore, your doctor may recommend other medicines to prevent organ damage:
- Ranitidine (Zantac)
- Cimetidine (Tagomet)
- Lansoprazole (Zoton)
It is important to inform your doctor if after taking the steroids there are pains in the abdomen.
Other side effects of steroids include:
- Elevated blood pressure.
- Sugar in the urine or increased blood sugar levels.
The doctor can advise on steroid diabetes. But this does not mean that the patient has become diabetic. sugar usually returns to normal after discontinuation of steroids.
Steroids can cause mood swings, insomnia, increased muscle mass. It is important that as soon as possible to draw attention to new symptoms and report them to doctors to specialists able to help.
These side effects usually develop only when the medicine is taken for some time. And disappear when steroid use is stopped.
Chemotherapy can reduce resistance to infection, so you should avoid people with colds and flu during this period.
Very rarely steroids cause psychosis. Man becomes excitable, mind - confused, he imagines things that are not true. This side effect is held after withdrawal of drugs.
Hematopoietic growth factors
These are substances that stimulate the bone marrow to the blood cell production. They are used to increase the number of leukocytes and stem cells. Used granulocyte colony stimulating factor (G-CSF, G-CSF). There are different types of G-CSF, filgrastim and lenograstim, pegfilgrastim.- long-term medication.
Drugs are administered in the abdomen, arms or legs. They are recommended for the following reasons:
- To expedite synthesis leukocytes after chemotherapy.
- To obtain more stem cells after they have collected.
Chemotherapy kills healthy white blood cells as well as cancer. The patient susceptible to infection until the level of white blood cells in the blood is low. If an infection develops, the body will not be able to fight it. Therefore, the infection can be life-threatening. Condition in which the low level of leukocyte, called neutropenia. Therefore, doctors use of hematopoietic growth factors during neutropenia to help the body produce white blood cells more quickly.
Hematopoietic growth factors used as in the preparation of the patient to collect the stem cells. Daily injections of these drugs increase the synthesis of stem cells. They are then collected, frozen and stored, to be applied after the transplant operation.
Injection of growth factors do not lead to the development of a large number of side effects. Some people noted itching at the injection site. After several injections, sometimes marked bone pain. This is because the bone marrow produces a large number of blood cells. Pain can be controlled with a mild painkiller - acetaminophen. It normally takes a few days.
In some cases, the temperature rises. It is important to inform the doctor because the fever may be a sign of infection.
Radiation therapy in the treatment of ALL in the Assuta
For the treatment of leukemia apply radiotherapy that affects the center. the nervous system.
As part of the transplant immature cells Radiation therapy is recommended for the whole organism - intensive care.
Careful planning is conducted, it is scanned by CT, MRI or PET.
If the recommended exposure area of the brain is made a mask that covers the face and the front part of the head, providing a fixed position.
Radiation therapy in transplantation
Can expose the entire body. Radiotherapy, destroying leukemia cells, destroys the bone marrow. Such treatment lymphoblastic leukemia twice a day for 3 or 4 days, or as a single session.
After completion of radiotherapy performed transplantation of stem cells or bone marrow by dropper.
Type of side effects depends on where it was applied. After irradiation of the head, you are likely to feel tired and nauseous. Possible hair loss. You can not sunbathe after treatment lymphoblastic leukemia several months. All due to the fact that radiotherapy does the treated skin more sensitive to the sun.
Irradiation of the body can cause diarrhea, inflammation of the oral cavity, and a high risk of infection. will need to be in hospital for some time.
There are problems with vision, many years after treatment of lymphoblastic leukemia - the development of cataracts. To prevent this complication, it is necessary to protect the eyes during total body irradiation. If all this happens, the problem can be solved with a simple operation.
Stem cell transplantation in the treatment of acute lymphoblastic leukemia in Israel
Acute lymphoblastic leukemia, doctors often offer aggressive treatment to try to cure cancer. It involves high-dose chemotherapy, and sometimes - and total body irradiation. However, such therapy destroys the cells of healthy cells. For this reason, a transplant immature (stem) cells or bone marrow from a donor or your own (rarely used now).
Selection between the donor of the graft and own material depends on a number of factors - such as leukemia and the presence of a close relative whose blood cells coincide with the recipient's cells.
This immature cells in the bone marrow that differentiate into blood cells. If the patient did injection of growth factors, the stem cells of the body will move into the bloodstream of the hematopoietic system. They are obtained by means of special devices - cell separator.
In the vein of the hand put a dropper, attach it to the separator. Blood enters the equipment, where it is filtered. The blood is then returned to the body via another drip. Doctors frozen stem cells and keep them.
Stem cell transplantation is similar to a bone marrow transplant, but the level of the cell is restored quickly. This reduces the risk of infection.
A large amount of research is currently devoted to the use of stem cells. It is now possible to use a transplant from a relative and non-relative donor. The advantages of stem cells is that there is no need for analgesics to collect them, the recovery process is achieved more quickly.
Collecting bone marrow cells
That small operation which is performed under general anesthesia. With the help of a large syringe doctor removes bone marrow from the pelvic bone or breast bone. A couple of days will need a mild sedative.
It uses the patient's own material. First of all, doctors harvested stem cells. If you can not remove them in sufficient quantities, harvested bone marrow. This treatment is rarely used in ALL.
In the remission phase when no signs of leukemia, harvested bone marrow or stem cells. They are then frozen prior to high-dose chemotherapy and possibly radiation therapy. Thereafter, they are returned to the body via a central catheter. Because of the risk of infection the patient is in a special isolation ward until the stem cells begin to produce new blood cells.
The best option of the donor - a close relative. Sometimes it is possible to choose an unrelated donor. Leukocytes are checked for compliance with the set of proteins - HLA through a special blood analysis.
The patient must be in remission. After application of cytotoxic drugs and radiotherapy is carried transplant.
In this situation, there is a risk of transplant rejection. This happens because the foreign cells can contain immune cells of the donor. These cells are sometimes recognize its own tissues as foreign and attack. This can be an advantage because the immune cells attack malignant segments remaining after treatment lymphoblastic leukemia.
GVHD reaction - graft versus host within 100 days after the transplant can cause diarrhea, weight loss, changes in the liver, skin rash. If GVHD develops, the doctor prescribes immunosuppressants.
Chronic GVHD occurs after more than 100 days after transplantation. In this case, the symptoms are manifested rash, diarrhea, joint pain and dry eyes. The doctor can recommend to avoid sun exposure, as skin rash often deteriorating under its influence.
After intensive treatment by cytotoxic drugs and exposure is carried out bone marrow transplant or stem cell. After a few days or weeks, they produce new blood cells.
While low levels of blood cells, the patient is in the hospital. It may take several weeks. At this time, there is a high risk of infection. It may need antiviral and antibacterial treatment, and sometimes antifungal therapy.
For many people, there are difficulties with the meal after an intensive treatment of lymphoblastic leukemia, because the digestive system is upset after chemo - and radiotherapy. Clinic nutritionist will assist in this matter. If the patient loses a large amount of weight can be assigned to intravenous nutrition.
Targeted therapy in the treatment of acute lymphoblastic leukemia in Israel
Targeted drugs work in different ways:
- To attack malignant cells.
- To help overcome the side effects caused by other treatment methods lymphoblastic leukemia.
Drugs - a tyrosine kinase inhibitors (CTI). They block the protein - tyrosine kinase, which promotes the development of cancer cells.
Imatinib mesylate (Gleevec) - CTI drug, often used in the treatment of chronic myeloid leukemia (CML). Currently, it is used in ALL, positive Philadelphia chromosome. Approximately 20% of patients have this mutation.
According to research, the use of imatinib in step induction increases the chances of achieving remission.
Possible side effects:
- changes in the skin (rash, redness or darkening);
- loss of appetite.
prices for treatment
Every disease - it is a separate case and therapy plan. For the treatment of acute lymphoblastic leukemia in Israel and affordable prices depend on the different stages of disease development. Each patient undergoes a diagnosis and find out the approximate cost to the procedure can be as follows:
- Oncologist Consultation - $ 600
- Chem. drugs - $ 360
- Chemotherapy in Israel - 1080 $ (per session)
In addition to these procedures, the doctor may prescribe radiation therapy or other approaches. So you know exactly how much it will cost treatment in Israel, send the application and documents with the diagnosis. Consultants estimate the price and inform.