Acute Lymphocytic Leukemia (ALL) Treatment

Acute lymphocytic leukemia (ALL) is a fast-growing type of cancer that can quickly progress. It is also called acute lymphoblastic leukemia. Treatment for ALL is based on several factors.

Factors that affect treatment include:¹

• The specific subtype of ALL
• The age of the person with ALL
• The general health of the person with ALL

Treatment for ALL should start soon after diagnosis. However, it can be helpful to get a second opinion if time safely allows. This can provide more information or other treatment options.^1,2

Types of treatment for acute lymphocytic leukemia

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

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

Chemotherapy

Chemotherapy is the term used to describe medicines given to stop the growth of cancer cells. Chemotherapy works by targeting fast-growing cells, such as cancer cells. But chemotherapy can cause unwanted side effects because it destroys all sorts of other fast-growing cells in the body. These include cells in the gut and hair.^1,3

Chemotherapy drugs may be used with other drugs or radiation, or alone. They may be taken by mouth or injected into a vein or muscle.^1,3

Radiation therapy

Radiation therapy uses high-energy radiation to kill cancerous cells. It may be used in cases of ALL that have spread to the cerebrospinal fluid (CSF) or the brain. It also may be used for ALL that has spread to the testicles.^1,3

Radiation therapy may be given in preparation for stem cell transplant. It also can be used for palliative care. Palliative means treatment that helps ease symptoms like pain. For example, it may reduce bone pain from leukemia.^1,3

Stem cell transplant

Stem cells are immature blood cells. Healthy stem cells may be taken from the person with cancer or a donor. These cells are then stored. After the person with ALL is given chemotherapy or radiation, the healthy stem cells are infused back into their body. This process helps their bone marrow produce health blood cells again.³

When the replacement stem cells come from a donor, it is called an allogeneic transplant. When the person's own stem cells are used, it is called an autologous transplant. Transplants used for ALL are usually allogeneic.³

Targeted therapy

Targeted therapies are ones that stop or slow the spread of cancer. They focus on features that are unique to cancer cells or block areas of cancer cells involved in growth.^1,3

Targeted therapy usually stops or slows the growth of cancer cells. This is different from chemotherapy, which often kills cancer cells. Targeted therapies are sometimes paired with chemotherapy to treat some types of ALL.^1,3

Two types of targeted therapies used to treat ALL are:^1,3

• Monoclonal antibody therapy – In this therapy, antibodies are created in a lab to identify and block cancer growth or kill cancer cells.
• Tyrosine kinase inhibitors (TKIs) – This therapy targets a specific protein found in 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. Some immunotherapy treatments may help cause remission. But they are often effective only in certain groups of people with ALL.¹

CNS prophylaxis therapy

Leukemia cells can sometimes hide in the central nervous system (CNS), which includes the brain and spinal cord. CNS prophylaxis is a treatment used to prevent leukemia from spreading to or coming back in the CNS. CNS prophylaxis usually takes the form of intrathecal (IT) chemotherapy and high-dose chemotherapy. These therapies are also used to treat existing cancer cells in the CNS.³

In IT chemotherapy, drugs are injected directly into the CSF. CSF is a clear liquid that surrounds the brain and spinal cord. IT chemotherapy is given in 2 ways:⁴

• Using an Ommaya reservoir – An Ommaya reservoir is a small plastic dome that sits on the skull. It has a thin tube that connects to the part of the brain that makes CSF.
• Injecting the chemotherapy drugs at the base of the spine

Figure 1. Intrathecal chemotherapy

Treatment phases

Treatment for ALL is generally grouped by phases:⁵

• Induction therapy – Given soon after diagnosis
• Consolidation therapy – May be given after induction to reduce the risk of recurrence
• Maintenance therapy – May be given to lower the risk of recurrence following induction and consolidation therapies

Clinical trials

Clinical trials are a type of research in which 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 get the latest treatments and be closely monitored by doctors.

You can learn more about clinical trials by talking to your doctor or visiting ClinicalTrials.gov. Your doctor can help you decide whether a clinical trial may be right for you.^1,6