Treatment Options for Acute Lymphocytic Leukemia (ALL)
Acute lymphocytic leukemia (ALL) is a type of cancer that affects the bone marrow where blood cells are made. ALL causes the bone marrow to make too many white blood cells.
The overall objective of treatment for ALL is to achieve remission, which means reducing or eliminating the signs and symptoms of cancer. Treatment for ALL aims to control the disease in the bone marrow and throughout the body, as well as prevent the spread of leukemia cells to the central nervous system (CNS).
Initial treatment of ALL typically occurs in phases. Within the phases, there may be cycles of treatments.
- Induction Phase: The first phase of treatment is called induction. The goal of this phase is to kill the leukemia cells in the blood and bone marrow and put the leukemia into remission. Remission means that the signs and symptoms of cancer are reduced or have disappeared.
- Consolidation Phase: This second phase may also be called intensification. It begins after ALL is in remission. The goal of this phase is to kill any remaining leukemia cells that may not be active but could begin to regrow. The aim is to help prevent a return (relapse) of ALL.
- Maintenance Phase: The goal of this phase is to prevent ALL from coming back.
Sometimes ALL doesn’t respond to initial treatment, or comes back (recurs or relapses). Treatment may depend on individual factors, such as whether ALL initial went into remission and the length of remission before ALL returned.
For some cases of ALL, further treatment may not likely be able to cure ALL (put ALL into remission). In these cases, the goals of treatment is to control symptoms such as pain. This type of treatment focused on symptoms may be called palliative treatment or supportive care.
It's important to note that treatment for ALL can vary depending on factors such as age, overall health, genetic characteristics of the cancer cells, and response to initial treatment. The length of treatment for ALL typically ranges from 1.5 to 3 years in order to eradicate the leukemic cell population.
Overall, the objective of treatment for ALL is curative in nature, aiming to achieve long-term remission and increase survival rates. Treatment strategies have improved over time, but outcomes can still vary depending on individual factors.
Successful treatment for ALL usually involves a combination of treatments, including chemotherapy, radiation therapy, targeted therapy, and sometimes stem cell transplantation.
- Chemotherapy is the cornerstone of treatment of ALL. It is given systemically (throughout the body) to control both bone marrow and systemic disease (cancer in other parts of the body).
- Combination Chemotherapy: Multiple drugs are typically used during the remission induction phase of ALL. The objective is to kill leukemia cells in the blood and bone marrow to put ALL into remission (reducing or eliminating the signs and symptoms of cancer).
- Chemotherapy is usually part of post-remission therapy to kill any remaining leukemia cells that may not be active but could regrow.
- Targeted Therapy: In certain patients, tyrosine kinase inhibitors may be used alongside chemotherapy. These targeted therapy drugs attack specific cancer cells with less harm to normal cells.
- Central Nervous System (CNS) Prophylaxis Therapy: ALL can spread to the brain and spinal cord. CNS prophylaxis therapy is used to prevent this. It involves chemotherapy administered either intrathecally (into the spinal fluid) or intravenously (into a blood vein). Sometimes radiation therapy to the brain is also used.
- STEM Cell Transplant: Some people who have specific genetic abnormalities or a small number of cancer cells that remain in the body after treatment (called persistent minimal residual disease, or MRD) may undergo a stem cell transplant. In STEM cell transplant, healthy stem cells are transplanted into their body to replace damaged or destroyed bone marrow. This involves a series of processes to collect stem cells, prepare the body to receive the stem cells, and the infusion (transplant) of stem cells.
- Supportive Care: Treatments may also be given to manage or prevent complications of ALL or its treatment. Examples of supportive care include:
- Antibiotics may be prescribed to prevent or treat infections, as ALL can weaken the immune system.
- Red blood cell and platelet transfusions or medications may also be given to help manage low blood counts.
- Antinausea medications (also called antiemetics) may be given to help with nausea side effects for chemotherapy and other treatments.
- Pain management may be initiated to help alleviate pain. It may include medications, radiation, or alternative therapies. Cancer centers often have a pain management specialist who can advise on possible treatments.
- Registered dietitian consultation may be available to advise on foods or nutritional supplements for people who are experiencing loss of appetite.
- Clinical Trials: Participating in cancer clinical trials can provide access to new treatment options that are being studied and may offer additional benefits. Many of these clinical trials are supported by the National Cancer Institute (NCI).
It's important to discuss the treatment plan with a healthcare team that specializes in treating leukemia. They can provide personalized recommendations based on an individual's specific condition and medical history.