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Treatments and drugs
By Mayo Clinic staffIn general, treatment for acute lymphocytic leukemia falls into separate phases:
- Induction therapy. The purpose of the first phase of treatment is to kill most of the leukemia cells in the blood and bone marrow.
- Consolidation therapy. Also called post-remission therapy, this phase of treatment is aimed at destroying the leukemia cells remaining in the brain or spinal cord.
- Maintenance therapy. The third phase of treatment prevents leukemia cells from regrowing. The treatments used in this stage are often given at much lower doses.
- Preventive treatment to the spinal cord. People with acute lymphocytic leukemia may also receive treatment to kill leukemia cells located in the central nervous system during each phase of therapy. In this type of treatment, chemotherapy drugs are injected directly into the fluid that covers the spinal cord. This kills cancer cells that can't be reached by chemotherapy drugs given by mouth or through an intravenous line.
Depending on your situation, the phases of treatment for acute lymphocytic leukemia can span 2 1/2 to 3 1/2 years.
Treatments may include:
- Chemotherapy. Chemotherapy, which uses drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases.
- Targeted drug therapy. Targeted drugs attack specific abnormalities present in cancer cells that help them grow and thrive. One targeted drug, imatinib (Gleevec), specifically attacks cancer cells that have a certain abnormality called the Philadelphia chromosome. The drug dasatinib (Sprycel) works in a similar way. These drugs are approved only for people with the Philadelphia chromosome-positive form of ALL.
- Radiation therapy. Radiation therapy uses high-powered beams, such as X-rays, to kill cancer cells. If the cancer cells have spread to the central nervous system, your doctor may recommend radiation therapy.
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Stem cell transplant. A stem cell transplant may be used as consolidation therapy in people at high risk of relapse or for treating relapse when it occurs. This procedure allows someone with leukemia to re-establish healthy stem cells by replacing leukemic bone marrow with leukemia-free marrow.
A stem cell transplant begins with high doses of chemotherapy or radiation to destroy any leukemia-producing bone marrow. The marrow is then replaced by bone marrow from a compatible donor (allogeneic transplant). In some cases, adults with ALL are able to use their own bone marrow for transplantation (autologous transplant). This may be possible if you go into remission and healthy bone marrow is then harvested for a future transplant.
- Clinical trials. Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, treatment benefits are still being evaluated. Discuss the benefits and risks of clinical trials with your doctor.
ALL in older adults
Older adults, such as those older than 65, tend to experience more complications from ALL treatments. And older adults generally have a worse prognosis than children who are treated for ALL. Discuss your options with your doctor. Based on your overall health and your goals and preferences, you may decide to undergo treatment for your ALL. Some people may choose to forego treatment for the cancer, instead focusing on treatments that improve their symptoms and help them make the most of the time they have remaining.
- Rabin KR, et al. Clinical manifestations of acute lymphoblastic leukemia. In: Hoffman R, et al. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa.: Churchill Livingstone; 2009. http://www.mdconsult.com/book/player/book.do?method=display&type=aboutPage&decorator=header&eid=4-u1.0-B978-0-443-06715-0..X5001-8--TOP&isbn=978-0-443-06715-0&uniq=210978719. Accessed Aug. 16, 2010.
- Hoelzer D, et al. Acute lymphocytic leukemia in adults. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone; 2007:2191.
- Pieters R, et al. Biology and treatment of acute lymphoblastic leukemia. Hematology and Oncology Clinics of North America. 2010;24:1.
- Acute lymphocytic leukemia. The Leukemia & Lymphoma Society. http://www.leukemia-lymphoma.org/all_page?item_id=7049. Accessed Aug. 16, 2010.
- Integrative medicine and complementary and alternative therapies as part of blood cancer care. The Leukemia & Lymphoma Society. http://www.leukemia-lymphoma.org/attachments/National/br_1150734030.pdf. Accessed Aug. 16, 2010.
- Faderl S, et al. Adult acute lymphoblastic leukemia. Cancer. 2010;116:1165.
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