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Treatments for acute lymphocytic leukemia
If you have acute lymphocytic leukemia (ALL), your healthcare team will create a treatment plan just for you. It will be based on your needs and may include a combination of different treatments. When deciding which treatments to offer for ALL, your healthcare team will consider:
- your age
- chromosome changes, or abnormalities
- the subtype of ALL
- your overall health
You may be offered the following treatments for ALL.
The main treatment for ALL includes receiving chemotherapy over a long period of time. Treatment is usually given in 3 phases, called induction, consolidation and maintenance. The total treatment usually takes 2–3 years.
An important part of ALL treatment is central nervous system (CNS) prophylaxis. CNS prophylaxis is treatment to make sure the leukemia does not spread to or stay in the fluid in and around the brain or spinal cord (called cerebrospinal fluid, or CSF).
People who have leukemia cells with the Philadelphia chromosome (Ph+ ALL) are often given a targeted therapy drug called a tyrosine kinase inhibitor as part of their chemotherapy treatment.
Radiation therapy may be offered as part of treatment for ALL. It is used:
- to prevent or treat spread of ALL to the central nervous system (CNS)
- in preparation for a stem cell transplant
- to relieve pain where the leukemia has spread to the bones (if chemotherapy hasn’t helped)
Radiation therapy is also sometimes used to shrink a tumour if it is pressing on the trachea or other vital organ.
Stem cell transplant
A stem cell transplant may be offered to people with ALL while they are in remission. It is also used following relapse if a complete or partial remission can be reached.
Stem cell transplant and the chemotherapy drugs used in preparation for a stem cell transplant can cause serious side effects, so not everyone can have this treatment. A reduced-intensity transplant may be an option for some people.
Supportive therapy is given to treat the complications that usually happen with treatments for ALL and the disease itself. Supportive therapy can include:
- antibiotics, antivirals or antifungals to prevent or fight infections
- transfusions of blood products to replace blood cells when counts are low
- growth factors, such as filgrastim (Neupogen), to stimulate the body to make white blood cells
- drugs to bring down high levels of some chemicals in the blood that increase when many cancer cells die at the beginning of treatment (called tumour lysis syndrome)
- leukapheresis to remove large numbers of white blood cells from the blood
Response to treatment
Knowing how well leukemia responds to treatment helps doctors determine prognostic risk group and plan future care. The goal of treatment is to reach a complete remission.
Complete remission, or complete response, means that the numbers of blood cells (red blood cells, white blood cells and platelets) have returned to normal levels and less than 5% of cells in the bone marrow are immature white blood cells (blast cells, blasts). There are no general signs or symptoms of ALL and no signs or symptoms that ALL has spread to the brain or spinal cord (called the central nervous system, or CNS) or anywhere else in the body.
Minimal residual disease (MRD) means that there are blasts in the bone marrow, but they can only be seen using very sensitive tests, such as flow cytometry or polymerase chain reaction (PCR). The blasts can’t be seen with standard tests, such as looking at the cells under a microscope.
Active disease means that the leukemia is still present during treatment or the disease comes back (relapses) after treatment. Active disease means that more than 5% of cells in the bone marrow are blasts.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 5 years after treatment has finished, even if there are no signs of the disease. The time between exams will become longer as time goes on, but you will need to have follow-up exams for a long period of time. These visits allow your healthcare team to monitor your progress and recovery from treatment.
Some clinical trials in Canada are open to people with ALL. Clinical trials look at new and better ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
A substance that regulates the growth, division and survival of cells.
Growth factors are found naturally in the body. They can also be made in a lab.
Growth factors are used in biological therapy.
A procedure that uses a special machine (pheresis machine) to separate and collect specific white blood cells from withdrawn blood. The remaining blood is then returned to the body.
Leukapheresis is used to lower a very high white blood cell count in people with cancer (leukemia) or to remove white blood cells for transfusion.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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