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Treatment

There are a variety of different treatments that you or your child may receive for acute lymphoblastic leukemia. It is likely treatment will begin rapidly after receiving a diagnosis.

Chemotherapy

Chemotherapy is the most common form of treatment for acute lymphoblastic leukemia. Chemotherapy works by killing rapidly dividing cells such as cancer cells. Treatment may involve the use of one or more chemotherapy drug at once, and often these agents are given straight into the bloodstream.

Phases of treatment

1. Induction phase with high doses of therapy

May last 1 or 2 months. The aim of the induction phase is to reduce the number of leukemia cells to a point when they are no longer found on bone marrow samples (called complete remission). After this point, the normal blood cells in the marrow can regrow. While achieving a complete remission is a positive sign, it does not necessarily mean the disease is cured, as leukemia cells may be present in other parts of the body.

2. Consolidation with high doses of therapy

May last 1 or 2 months. The consolidation phase is designed to stop the acute lymphoblastic leukemia coming back and to destroy any leukemia cells that may be present in the blood but that are in such small numbers they do not show up on tests.

3. Maintenance

Maintenance is a less intense treatment phase that can last up to 2 years. It aims to maintain remission using lower doses of chemotherapy over a long period of time. Side effects should be less during this phase, allowing the return to normal activities.1

Common chemotherapy agents used include:

  • Asparaginase
  • Vincristine
  • Cyclophosphamide
  • Cytarabine
  • Doxorubicin
  • Methotrexate
  • Steroids such as dexamethasone, prednisolone, and hydrocortisone taken before or alongside chemotherapy

Targeted treatment and immunotherapy

These types of treatment target specific parts of cancer cells and may be more effective at treating certain subtypes.

The Philadelphia chromosome is the name given to the product of swapping specific genetic material between chromosomes 9 and 22. This change is sensitive to treatment by tyrosine kinase inhibitors such as:

  • Imatinib
  • Dasatinib
  • Ponatinib

Immunotherapy

Immunotherapy can be considered to be a specialized form of targeted therapy that uses specifically designed antibodies to treat acute lymphoblastic leukemia. Immunotherapy aims to encourage the patient’s immune system to target and kill leukemia cells.

The two main immunotherapeutic agents you may be treated with are:

  • Blinatumomab
  • Inotuzumab ozogamicin2

Chimeric antigen receptor (CAR) T-cells

CAR T-cells are a very new type of treatment for acute lymphoblastic leukemia. White blood cells from the patient are taken from the blood and engineered in the lab to specifically kill leukemic cells. These white blood cells are now called CAR T-cells and are multiplied before being given back to the patient. Tisagenlecleucel is a CAR T-cell product that can be used to treat acute lymphoblastic leukemia.3

Radiation therapy or radiotherapy

High doses of targeted radiation, normally called X-rays, can be used to treat cancer, and this technique is called radiotherapy. This may be performed on the brain or spinal cord if the leukemia appears to have spread to these areas. Alternatively, radiotherapy may be used over the whole body (known as total body irradiation) prior to a stem cell transplant.

Stem cell or bone marrow transplant

This procedure is used following chemotherapy or radiotherapy. High intensity treatment is used to kill the leukemic cells in the bone marrow (the spongy part of the bone); however, normal blood cells are killed too.

A transplant is used to replace the blood cells with healthy cells that function correctly. The healthy cells are normally provided by a donor. In a transplant, these healthy cells can be taken from the bone marrow or from the bloodstream.

Side effects3

Although many treatments for acute lymphoblastic leukemia are very good at killing cancer cells, some normal healthy cells may be damaged or killed during treatment as well. This may result in side effects.

For chemotherapy, traditional side effects associated with treatment are:

  • Nausea and vomiting
  • Loss of appetite
  • Fatigue
  • Mouth ulcers
  • Diarrhea
  • Hair loss
  • Infertility
  • Skin rashes

Immunotherapy may increase the risk of infection along with:

  • Headaches
  • Fever
  • Muscle aches
  • Dizziness
  • Bleeding
  • Feeling and being sick4

CAR T-cell therapy may result in serious side effects, for this reason it is only given in specialized medical centers by trained staff. The most common side effects include:

  • Cytokine release syndrome (CRS): symptoms including fever, chills, difficulty breathing, severe nausea, vomiting, diarrhea, severe muscle or joint pain, and feeling dizzy
  • Nervous system problems: can present as headaches, changes in consciousness, confusion or agitation, seizures, trouble speaking and understanding, or loss of balance
  • Infections
  • Low blood cell counts

References

1. Cancer Research UK. About chemotherapy for ALL. https://www.cancerresearchuk.org/about-cancer/acute-lymphoblastic-leukaemia-all/treatment/chemotherapy/about. Published May 8, 2018. Accessed Mar 29, 2021.

2. American Cancer Society. Targeted therapy for acute lymphocytic leukemia (ALL). https://www.cancer.org/cancer/acute-lymphocytic-leukemia/treating/targeted-therapy.html. Published Oct 17, 2018. Accessed Mar 29, 2021.

3. American Cancer Society. Immunotherapy for acute lymphocytic leukemia (ALL). https://www.cancer.org/cancer/acute-lymphocytic-leukemia/treating/monoclonal-antibodies.html. Published Oct 17, 2018. Accessed Mar 29, 2021.

4. NHS. Treatment. https://www.nhs.uk/conditions/acute-lymphoblastic-leukaemia/treatment/ Published Sep 30, 2019. Accessed Mar 29, 2021.

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What is acute lymphoblastic leukemia?Causes & symptomsDiagnosisTypesTreatmentPrognosisRemissionRelapse

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