Treatment

Common Treatments for Leukemia

Bone marrow transplant (BMT) and peripheral blood stem cell transplant (PBSCT) are most commonly used in the treatment of leukemia and lymphoma. They are most effective when the leukemia or lymphoma is in remission (the signs and symptoms of cancer have disappeared). BMT and PBSCT are also used to treat other cancers such as neuroblastoma (cancer that arises in immature nerve cells and affects mostly infants and children) and multiple myeloma. Researchers are evaluating BMT and PBSCT in clinical trials (research studies) for the treatment of various types of other cancer.

One reason BMT and PBSCT are used in cancer treatment is to make it possible for patients to receive very high doses of chemotherapy and/or radiation therapy. To understand more about why BMT and PBSCT are used, it is helpful to understand how chemotherapy and radiation therapy work.

Chemotherapy and radiation therapy generally affect cells that divide rapidly. They are used to treat cancer because cancer cells divide more often than most healthy cells. However, because bone marrow cells also divide frequently, high-dose treatments can severely damage or destroy the patient’s bone marrow. Without healthy bone marrow, the patient is no longer able to make the blood cells needed to carry oxygen, fight infection, and prevent bleeding. BMT and PBSCT replace stem cells destroyed by treatment. The healthy, transplanted stem cells can restore the bone marrow’s ability to produce the blood cells the patient needs.

Remission induction therapy: This is the first phase of treatment. The goal is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.

Post-remission therapy: This is the second phase of treatment. It begins once the leukemia is in remission. The goal of post-remission therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse. This phase is also called remission continuation therapy.

Central nervous system (CNS) sanctuary therapy: This is usually given during each phase of therapy. Because standard doses of chemotherapy may not reach leukemia cells in the CNS (brain and spinal cord), the cells are able to "find sanctuary" (hide) in the CNS. High doses of certain anticancer drugs, intrathecal chemotherapy, and radiation therapy to the brain are able to reach leukemia cells in the CNS. They are given to kill the leukemia cells and keep the cancer from recurring (coming back). CNS sanctuary therapy is also called CNS prophylaxis.

Bone marrow and peripheral blood stem cell transplantation

• Autologous transplant: patient receives their own stem cells
• Allogeneic transplant: patient receives stem cells from a family member or matched unrelated donor, cord blood transplants
• Syngeneic transplant: patient receives stems cells from their identical twin

Common Treatments for Lymphoma

Treatment for non-Hodgkin lymphoma depends on the cell type and stage at diagnosis. Treatment for both Hodgkin lymphoma and non-Hodgkin lymphoma is usually radiation therapy (for early stage disease, Stage I and II) and/or chemotherapy (for stage III and IV cases), but this may vary by cell type.

• For example, low grade, low stage non-Hodgkin lymphoma may be treated with radiation only, whereas intermediate grade, low stage NHL should receive radiation and chemotherapy, and high-grade, low stage NHL would likely receive chemotherapy only.

Lymphomas, particularly NHL, can convert to a more aggressive form after initial treatment.
Low grade non-Hodgkin lymphomas respond to chemotherapy and radiation but continue to relapse for a long period of time.

Radiation is commonly used in low stage Hodgkin lymphoma and non-Hodgkin lymphomas (Stage I and II). Patients with higher stage disease may be treated with radiation to reduce tumor mass or bulky disease. Usually, patients are treated with radiation on only one side of the body (above or below the diaphragm). Radiation may also be given for central nervous system prophylaxis, or for intracranial metastases.

Surgery may also be done to remove the lymphoma, especially if an organ is involved or it involves a single lymph node or lymph node region. Other types of therapies include hormones, bone marrow and stem cell transplants.

There are several factors that affect prognisis (chance of recovery/survival) and treatment options for when there is a recurrence of the lymphoma or transformation to another lymphoma

• Stage of the cancer
• Cell type of lymphoma
• Amount of lactate dehydrogenase (LDH) in the blood
• Amount of beta-2-microglobulin in the blood (for Waldenström macroglobulinemia)
• Patient’s age and general health
• New lymphoma or recurrence

Note: In patients with a history of lymphoma, a positive bone marrow biopsy typically indicates disease progression or histologic transformation, rather than a new primary lymphoma.

• Transformation suggests evolution to a more aggressive subtype and has implications for prognosis and treatment strategy.

Neoadjuvant Therapy

Neoadjuvant therapy does not apply to hematopoietic neoplasms.

Updated: December 2, 2025