Treatment for HE or CEL includes support of the blood count with red cell transfusions, and medication with drugs such as hydroxyurea, interferon alpha, or irradiation treatment. Patients with the FIP1PDGFR change are especially sentive to drugs like Glivec.
Occasionally, a bone marrow transplant might be recommended his is done either by using the patient’s own bone marrow or that of a related or unrelated donor. We only use bone marrow transplants rarely due to the high risks associated with it.
The onset of acute myeloid leukaemia can have a poor outlook, as this form of leukaemia is often resistant to treatment.
If you have HE or CEL it is usually necessary to use drugs to control the eosinophil count and reduce the chance of tissue damage. Until very recently the main options were the same as those to control the blood count - hydroxyurea, and more rarely busulphan, interferon alpha, and radioactive phosphorus. Steroid tablets can also be used, mainly to limit inflammation or swelling of the tissues. If they are used in high doses over a long time they can cause diabetes, thinning of bones (osteoporosis), high blood pressure, and shorter term complications including weight gain and mood and sleep disturbance. For patients with FIP1PDGFR a newer drug called Glivec can be used.
This drug interferes with cell metabolism. It is a daily treatment; blood counts need monitoring every two to three months. The side effects include some darkening of skin, mouth and leg ulcers, and sometimes stomach problems. Hydroxyurea can damage cells and may affect fertility. Women who are pregnant or trying to conceive should not use it. There is a small chance that hydroxyurea increases the risk of leukaemia.
- Melphalan, busulphan and radioactive phosphorous
Melphalan, busulphan or radioactive phosphorous were the main therapies used to treat PV. However, all of these are capable of causing damage to fertility and the bone marrow, and are known to increase the chance of the disease changing into acute leukaemia. We still use both busulphan and radioactive phosphorous to treat PV when other drugs are not working, when there are side effects, or when it is difficult to take the hydroxyurea tablets.
Interferon Alpha is a natural agent that reduces the production of bone marrow cells. We use it in patients who are pregnant or who want to preserve fertility. We give interferon alpha by injection three times a week. The side effects are flu-like symptoms, hair loss, depression, and liver and thyroid changes. This drug does not increase risk of leukaemia.
- Glivec, STI571 or imatinib
More recently for some patients in whom specific changes in the genetic structure of the cells have been found a drug called glivec (Imatinib or STI 571) has produced very dramatic results. Glivec is a drug designed to block the action of an abnormal enzyme formed by these genetic changes. There is little information about whether glivec controls this disease over many years. Glivec is taken as a tablet the side effects include low blood counts, rashes, swelling especially over the eyes. It is unlikely to cause leukaemia in the long term but is not safe to use in pregnancy.
- Medication for other problems
We control gout by reducing the number of red cells and using allopurinol to reduce the symptoms. We treat an acute attack of gout with painkillers. Itching can be a particularly difficult problem to control. We can use creams and ranitidine to ease the symptoms. Other treatments may be needed to control and treat symptoms of tissue damage, for example water tablets and inhalers.
If you'd like to read more about treatments, both conventional and alternative, please click here to go to the Treatments main page
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