“Standard to care” refers to the best-known treatment, in cancer care, different doctors work together to bring out an overall treatment plan for the patient. This is a multidisciplinary team.
Treatments recommendations depend on many factors:
- The size, grade and type of tumor
- Whether the tumor is applying pressure on vital parts of the brain
- If the tumor has increased to other parts of the body
- Possible side effects
- The patient’s preferences and overall health
Chemotherapy
Chemotherapy uses medicine to kill or stop the growth of cancerous cells. Depending upon the stage, the doctors give different chemotherapy. The point that makes a difference is how the chemotherapy enters the body and which cells it affects.
Systemic chemotherapy enters the bloodstream to reach cancerous cells all over the body.
A chemotherapy schedule usually consists of a certain number of cycles over a fixed period. A patient have one drug at a time or a combination of different drugs given simultaneously.
Chemotherapy used to treat eosinophilic leukemia includes,
- Corticosteroids such as prednisone (multiple brand names)
- Hydroxyurea (Droxia, Hydrea)
- Vincristine (Vincasar)
- Cyclophosphamide (Neosar)
The side effects depend on the patient and the dose used. Still, they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go after treatment is complete.
Surgery
The spleen helps form the body’s white blood cells. Surgery to remove the spleen is splenectomy. Doctors suggest this for some patients.
Before surgery, talk to the health care team about the possible side effects of the specific surgery.
Immunotherapy
Immunotherapy, a type of biological therapy, uses artificial or natural substances to harness our immune system to fight.
It uses materials formed either by the body or in a laboratory to improve, target, or restore immune system function.
Recombinant interferon-alpha (Alferon, Infergen, Intron A, Roferon-A) is a biologic therapy that is occasionally treats eosinophilic leukemia.
Different types of immunotherapy can cause various side effects.
Targeted Therapy
Targeted therapy aims at any factor contributing to the growth and development of cancer cells. It can be a specific protein, gene or tissue environment and this treatment blocks the growth and spread of tumor cells while limiting damage to healthy cells.
In many patients with hypereosinophilic syndrome, the leukemia cells have a specific genetic change that makes an abnormal protein called the FIP1-like-1/platelet-derived growth factor-alpha. This abnormal protein stimulates the cells to grow.
Imatinib (Gleevec) is a drug that stops enzymes known as tyrosine kinases from working and can destroy abnormal eosinophils by blocking the effect of the FIP1-like-1-platelet-derived growth factor-alpha protein. Imatinib is more likely to work for patients whose leukemia has this genetic mutation. However, even if leukemia does not have this mutation, there is still a possibility that the drug will work, Imatinib can quickly improve blood counts and symptoms for many patients and many years if the patient takes the drug regularly.
The main side effects of imatinib include swelling around the eyes, headache, fatigue, leg swelling, muscle cramping, rash, and also joint pain.
If this treatment works, it usually continues throughout a person’s lifetime. For patients who cannot take imatinib or if imatinib stops working, the drugs nilotinib (Tasigna) or dasatinib (Sprycel) may be other options.
Stem cell Transplantation/Bone marrow Transplantation
A stem cell transplant is a medical process in which highly specialized cells replaces the bone marrow that contains the cancer. These cells, known as hematopoietic stem cells, develop into the healthy bone marrow. Hematopoietic stem cells are the blood-forming cells found in the bloodstream and the bone marrow. These stem cells form all of the healthy cells in the blood. Presently, this procedure is more commonly called a stem cell transplant than a bone marrow transplant because it is the stem cells in the blood typically being transplanted, not the actual bone marrow tissue.
Before suggesting transplantation, doctors talk to the patient and family members regarding the risks of this treatment. They will also consider several other factors, like age and general health, cancer type, and previous treatment results.
Transplantation is a higher-risk treatment and is not used often for people with eosinophilic leukemia because it is not always effective for this disease. Many patients with this disease are older, and the procedure’s risks are higher.
There are two types of stem cell transplantation depending on the source of the replacement blood stem cells – autologous (AUTO) and allogeneic (ALLO). AUTO uses the patient’s stem cells, while ALLO uses donated stem cells. In both types, the goal is to destroy all cancer cells in the blood, marrow, and other body parts using high doses of chemotherapy or radiation therapy and then allow replacement blood stem cells to create healthy bone marrow.
Side effects depend on general health, the type of transplant, and other factors.
Palliative Care
Cancer and its treatment have side effects that can be mental, physical or financial and managing the effects are palliative or supportive care.
Palliative care includes medication, nutritional changes, emotional and spiritual support and other relaxation therapies.
Palliative care focuses on alleviating how you feel during treatment by managing symptoms and supporting patients and their families with other non-medical needs. Regardless of type and stage of Cancer age, any person may receive this type of care.
Palliative care for eosinophilic leukemia may include the following treatments:
- Steroid medications are used to control some symptoms of eosinophilic leukemia.
- Radiation therapy uses high-energy x-rays or other particles to destroy cancer cells. A doctor specializing in radiation therapy to treat cancer is called a radiation oncologist. The most common radiation therapy type is external-beam radiation therapy, which is radiation from a machine outside the body. When radiation therapy is given using implants, internal radiation therapy or brachytherapy. A radiation therapy schedule consists typically of a specific number of treatments offered over a set period. Side effects from radiation therapy include mild skin reactions, upset stomach, fatigue, and loose bowel movements. Most side effects go soon after treatment is finished.
Refractory Eosinophilic Leukemia
If leukemia continues to worsen despite treatment, it is called refractory leukemia and if this happens, it is good to talk to doctors who have experience treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials can be an option.
The treatment plan may include a combination of chemotherapy, immunotherapy, and targeted therapy. Palliative care will also be essential to help relieve symptoms and side effects.
Remission and chance of recurrence
When cancer can’t be detected in the body, and there are no symptoms, this is known as remission and this may be called having ‘no evidence of disease’.
A remission can be temporary or permanent. Many people worry about the recurrence of cancer.
The doctor performs another round of tests to know the extent of the recurrence.
Mainly the treatment plan includes the treatments explained above, like surgery, chemotherapy, radiation therapy, and targeted therapy.
If treatment doesn’t work
If cancer can’t be treated or controlled, it leads to advanced or terminal cancer. It is vital to have straightforward conversations with your health care team to express your feelings, preferences, and concerns. The health care team has unique skills, knowledge, and experience to assist patients and their families. Ensuring that a person is physically comfortable, free from pain, and emotionally supported is extremely important.
