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.¹

Treatment for ALL is based on several factors, such as:¹

• The specific type 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. If time safely allows, it can be helpful to get a second opinion. A second opinion can provide more information or other treatment options.^1,2

Types of treatment for ALL

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

• Chemotherapy
• Radiation therapy
• Stem cell transplant
• Targeted therapy
• Immunotherapy
• Central nervous system (CNS) prophylaxis therapy (a form of chemotherapy)
• Steroids

Chemotherapy

Chemotherapy is the term for medicines that 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 can also impact other fast-growing cells in the body, such as cells in the gut and hair.^1,3

Chemotherapy drugs are the main treatment for many people with ALL. They may be used with other drugs, radiation, or alone. They may be taken by mouth or injected into a vein, into muscle, or under the skin, depending on the specific medication.^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. CSF is a clear liquid that surrounds the brain and spinal cord. Radiation therapy also may be used for ALL that has spread to the testicles.^1,3

Radiation therapy may be given in preparation for a stem cell transplant. It can also be used for palliative care. Palliative care 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 ALL or a donor. These cells are then stored. After the person with ALL is given chemotherapy and/or radiation, the stem cells are put back into their body. This process helps their bone marrow produce healthy 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. Stem cell transplants used for ALL are usually allogeneic.³

Targeted therapy

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. Targeted therapies target features that are unique to cancer cells or block areas of cancer cells involved in growth.^1,3

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

• Tyrosine kinase inhibitors (TKIs) – drugs that block abnormal proteins that help cancer cells grow
• Antibody-drug conjugates – therapies that deliver chemotherapy drugs directly to cancer cells

Immunotherapy

Immunotherapy boosts the body's own immune system to kill cancer cells. They may be considered a type of targeted therapy in some circumstances.¹

Some immunotherapies used to treat ALL include:^1,4-9

• Chimeric antigen receptor (CAR) T-cell therapy – During CAR T-cell therapy, T cells are removed from your body, altered to attach to cancer cells, and put back into your blood.
• Bispecific T-cell engagers (BiTEs) – BiTE therapies use antibodies to help T cells interact with cancer cells.

Currently, many of these therapies are only approved for certain types of ALL that have relapsed (come back) or are refractory (not responding to other treatments), but some may be used in other scenarios as well.^3-6

CNS prophylaxis therapy

Leukemia cells can sometimes hide in the CNS. The CNS includes the brain and spinal cord.³

CNS prophylaxis attempts to prevent leukemia from spreading to the CNS. CNS prophylaxis may include high-dose chemotherapy, intrathecal (injected into the fluid surrounding the brain and spinal cord) chemotherapy, and/or radiation therapy.³

Intrathecal chemotherapy is given in 2 ways:¹⁰

• Using an Ommaya reservoir (a small plastic dome that sits on the skull with a thin tube that connects to the part of the brain that makes CSF)
• Injecting the chemotherapy drugs at the base of the spine

Steroids

All treatments for ALL involve steroids. Steroids help fight inflammation. They are also toxic to lymphoid cells, which have a role in the development of ALL. Corticosteroids and glucocorticoids are the types of steroids that may be used to treat ALL.²

Treatment phases

Treatment for ALL is generally grouped into phases:¹¹

1. Induction therapy – Given soon after diagnosis
2. Consolidation therapy – Given after induction to reduce the risk of the cancer coming back (recurrence)
3. Maintenance therapy – 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 while being closely monitored by doctors.¹²

You can talk to your doctor or visit ClinicalTrials.gov to learn more about clinical trials. Your doctor can help you decide whether a clinical trial may be right for you.^1,12