Acute Lymphocytic Leukemia (ALL) Treatment

Treatment for acute lymphocytic leukemia (also called acute lymphoblastic leukemia, or ALL) is based on several factors, including:¹

• The specific subtype of ALL
• Age of the person with ALL
• Their general health

Treatment for ALL should start soon after diagnosis because it is a fast-growing type of cancer that can quickly progress. However, it can be helpful to get a second opinion if time safely allows. This can provide more information or other treatment options.¹

Types of treatment for acute lymphocytic leukemia

There are several different types of treatment used for ALL, including:^3,4

• Chemotherapy
• Radiation therapy
• Stem cell transplant
• Targeted therapy
• Immunotherapy

Chemotherapy

Chemotherapy is the use of drugs to stop cancer cells. Chemotherapy works by targeting fast-growing cells, such as cancer cells. However, there are other fast-growing cells in the body that can also be affected, such as those in the gastrointestinal tract and hair.^1,4

Chemotherapy drugs may be used together with other drugs or alone. They may be taken by mouth or injected into a vein or muscle.^1,4

Radiation therapy

Radiation therapy uses high-energy radiation. It may be used in cases of ALL that has spread to the cerebrospinal fluid (CSF) and/or the brain, or for ALL that has spread to the testicles.^1,4

Radiation therapy may be given in preparation for stem cell transplant. Radiation can also be used for palliative care. This is a treatment that helps ease symptoms like pain, such as when it is given to reduce bone pain from leukemia.^1,4

Stem cell transplant

A stem cell transplant uses high doses of chemotherapy, which destroys the cancerous cells. Next, bone marrow stem cells are replaced. The replacement stem cells may be from a donor (allogeneic transplant). Or, the stem cells of the person (autologous transplant) may be removed from the bone marrow or blood before they receive chemotherapy.⁴

Targeted therapy

Targeted therapies are cancer treatments that block or slow the spread of cancer. They do this by interfering with specific areas of cancer cells involved in growth or by focusing on specific features that are unique to cancer cells.^1,6

While chemotherapy drugs often kill cancer cells, targeted therapy usually blocks the growth of cancer cells. Targeted therapies may be used along with chemotherapy to treat certain types of ALL. Two types of targeted therapies used to treat ALL include:^1,6

• Monoclonal antibody therapy – These antibodies are created in the lab to identify and block cancer growth or kill cancer cells
• Tyrosine kinase inhibitors (TKIs) – This therapy targets a specific protein found on certain cancer cells

Immunotherapy

Immunotherapy is a type of cancer treatment that aims to boost the body's own immune system to kill cancer cells. While some immunotherapy treatments may help induce remission, they are often only effective in certain groups of people with ALL.³

CNS prophylaxis therapy

Leukemia cells can sometimes be found in the central nervous system (CNS), which includes the brain and spinal cord. A kind of treatment called CNS prophylaxis (or CNS sanctuary therapy) is used to treat any leukemia cells in the CNS. Because standard chemotherapy may not reach the CNS, high doses of chemotherapy, intrathecal chemotherapy (injected directly into the space around the brain and spinal cord, as shown below), or radiation therapy may be used as CNS prophylaxis therapy.⁴

Figure 1. Intrathecal chemotherapy

Treatment phases

Treatment for ALL is generally categorized by phases:⁷

• Induction therapy, which is treatment that is started soon after diagnosis
• Consolidation therapy, which may be given after induction to reduce the risk of a relapse
• Maintenance therapy, which may be given to lower the risk of recurrence following induction and consolidation therapies

Clinical trials

Clinical trials are a type of research where new treatments are studied. Clinical trials are an important part of the scientific process to find and prove the safety and effectiveness of new treatments. They offer people a chance to receive the latest treatments and be closely monitored by doctors. You can learn more about clinical trials by talking to your doctor or visiting the ClinicalTrials.gov website. Your doctor can help you decide if a clinical trial may be right for you.^1,7,8