Acute Lymphocytic Leukemia (ALL) Treatment

Treatment for acute lymphocytic leukemia (also called acute lymphoblastic leukemia, or ALL) is based on several factors, including the particular subtype of ALL, the age of the individual, and their general health. Treatment for ALL should start promptly after diagnosis, as ALL is a type of cancer that is fast growing and can progress quickly, however, it can be helpful to get a second opinion (if time safely allows), which can provide additional information or other treatment options.¹

Types of treatment for acute lymphocytic leukemia

There are several different types of treatment that may be used for ALL, including:

• Chemotherapy
• Radiation therapy
• Stem cell transplant
• Targeted therapy
• Immunotherapy^3,4

Chemotherapy

Chemotherapy is the use of drugs to stop cancer cells. Chemotherapy medications may be used in combination, and chemotherapy drugs may be taken by mouth or injected into a vein or muscle. 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

Radiation therapy

Radiation therapy uses high-energy radiation, and 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. Radiation can also be used for palliative care, treatment that helps ease symptoms like pain, such as when it is given to reduce bone pain due to leukemia. Additionally, radiation therapy may be given to a patient’s entire body in preparation for stem cell transplant.^1,4

Stem cell transplant

A stem cell transplant uses high doses of chemotherapy, which destroys the cancerous cells, followed by replacement of bone marrow stem cells. The replacement stem cells may be from a donor (called an allogeneic transplant), or the stem cells of the patient (called an autologous transplant) may be removed from the bone marrow or blood prior to the administration of high-dose chemotherapy.⁴

Targeted therapy

Targeted therapies are cancer treatments that block or slow the spread of cancer by interfering with specific areas of cancerous cells that are involved in the cancer cell's growth, or by focusing on particular characteristics that are unique to cancer cells. While chemotherapy drugs are often cytotoxic, meaning they kill cancer cells, targeted therapy is typically cytostatic, meaning it blocks the growth of cancer cells. Targeted therapies may be used in combination with chemotherapy to treat certain types of ALL. Two types of targeted therapies that may be used to treat ALL are monoclonal antibody therapy and tyrosine kinase inhibitors (TKIs). Monoclonal antibodies are created in the laboratory to identify and block cancer growth or kill cancer cells. TKIs target a specific protein that is 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 aid in inducing remission, they are often only effective in certain subsets of people with ALL.³

CNS prophylaxis therapy

Leukemia cells can sometimes be present in the central nervous system (CNS), which is composed of 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:

• Induction therapy, treatment that is begun 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 therapies⁷

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, and they offer patients a chance to receive the latest treatments and be closely monitored by healthcare professionals. Clinical trials can be found by talking to a doctor or through the website ClinicalTrials.gov. Patients can discuss treatment options with their doctor to determine if they might be eligible to participate in a clinical trial.^1,7,8