Acute Lymphoblastic Leukemia Treatment

Most cancers are divided into stages, based on how far they’ve spread. But with ALL, doctors describe it according to treatment.

• Untreated. This is a new diagnosis. You might have been treated for symptoms but not for the cancer itself.
• Remission. You’ve had treatment to kill as many leukemia cells as possible. Your CBC is normal, and no more than 5% of cells in your bone marrow are leukemia cells.
• Recurrent. This is cancer that’s come back after treatment and remission.

Acute Lymphoblastic Leukemia Treatment

Treatment happens in two parts: induction therapy, to put you in remission, and post-remission therapy.

You may have more than one type of treatment. These include:

• Chemotherapy. You might take a mix of drugs that kill or slow cancer cells, usually over a couple of years.
• Targeted therapy. Some drugs target specific parts of cancer cells and tend to have fewer or milder side effects than chemotherapy. They include bosutinib (Bosulif), dasatinib (Sprycel), imatinib (Gleevec), nilotinib (Tasigna), and ponatinib (Iclusig).
• Radiation therapy. Your doctor might use high-energy radiation to kill cancer cells if they’ve reached your brain or bone or before you have a stem cell transplant.
• Immunotherapy. These drugs boost your immune system to kill or slow the growth of cancer cells. They include blinatumomab (Blincyto) and inotuzumab ozogamicin (Besponsa). The FDA has also approved a form of treatment called CAR T-cell therapy. It uses some of your own immune cells, called T cells, to treat your cancer. Doctors take the cells out of your blood and add genes to them. The new T cells are better able to find and kill cancer cells.
• A stem cell transplant. After high doses of chemotherapy and possibly radiation, you get stem cells that will grow into healthy blood cells. They might be your own or come from a donor. If you can’t handle high doses of chemotherapy and radiation, you might get lower doses with a “mini-transplant.”

About 80% to 90% of adults reach remission after treatment. For about 30% to 40%, the cancer doesn’t return. But many relapse, meaning the disease returns.

You’ll need post-remission therapy to keep the cancer from coming back. This involves cycles of treatment over 2 to 3 years. It aims to rid your body of leukemia cells.

The FDA has also approved a form of treatment called CAR T-cell therapy. It uses some of your own immune cells, called T cells, to treat your cancer. Doctors take the cells out of your blood and add genes to them. The new T cells are better able to find and kill cancer cells.

The drug, tisagenlecleucel (Kymriah), is approved only for children and young adults up to age 25 who have a certain type of ALL and haven’t gotten better with other treatments. But scientists are working on a version of CAR T-cell therapy for adults and for other kinds of cancer.

You might also consider joining a clinical trial to test new treatments that aren’t widely available. Talk to your doctor about which one would be the best fit for you and about what to expect.

Acute Lymphoblastic Leukemia Prognosis

The outlook for acute lymphoblastic leukemia depends on several things, including:

• Your age. Younger patients tend to do better.
• Your lab test results. The prognosis is better if you have a lower white blood count when you’re diagnosed.
• Your chromosomes. People who don’t have a problem in their genes called the Philadelphia chromosome usually do better.
• Your response to chemotherapy. The prognosis is better if you have no evidence of leukemia 4 to 5 weeks after starting treatment.

You’ll need follow-up tests for several years after treatment to check your overall health and be sure the cancer doesn’t come back.

It’s natural to feel worried when you’ve been diagnosed with cancer. Reach out to loved ones, religious groups, counselors, or support groups for help and support.