Physicians develop a course of treatment for each ALL patient that takes a number of factors into account. It is for this reason that ALL patients with the same subtype may receive different treatments. The factors include:
- the ALL subtype
- whether the patient has been treated already, with what, and how successfully
- the number of leukemic cells detectable in the blood
- any chromosomal alterations found
- the patient's age and overall health
Doctors may recommend different treatments for ALL patients with the same disease subtype after considering these factors.
The standard treatment approaches for adult leukemia are chemotherapy and bone marrow transplantation. Radiation therapy — treatment with high-energy rays that destroy cancer cells — is sometimes used for leukemia in the central nervous system or testicles and for pain caused by bone destruction. Because leukemia is a systemic disease that affects the whole body, surgery is almost always ineffective.
Treatment for ALL is typically divided into three phases:
Descriptions of each phase of treatment are below.
During the induction phase doctors work to induce a remission — a state in which there is no visible evidence of disease and blood counts are normal. Doctors may use a combination of drugs including vincristine, prednisone, L-asparaginase, doxorubicin, daunorubicin, or cyclophosphamide. More recently, induction regimens using high doses of the chemotherapeutic agents cytarabine and mitoxantrone have been explored in an attempt to improve outcomes for adult patients with ALL. Treatment can last up to four weeks, and patients may need to be hospitalized during induction therapy.
During the consolidation phase, a secondary treatment is given to kill any cancer cells that may be left in the body. Treatments may include radiation therapy, a stem cell transplant, or chemotherapy. This phase may last several months.
During the maintenance phase, patients may receive lower doses of drugs but for long periods of time — typically for two years — to destroy any remaining leukemia cells that have evaded the drugs already used; these cells are usually not be detectable by laboratory tests. Commonly used drugs for maintenance include methotrexate, 6-mercaptopurine, vincristine, and prednisone.
Treatment for Ph-Positive ALL
Between 20 and 30 percent of adult ALL patients have a chromosomal abnormality called the Philadelphia chromosome and a type of ALL called Ph-positive (or Philadelphia-positive). These patients may receive a drug called imatinib mesylate (Gleevec®), or related drugs, such as dasatinib (Sprycel®) or nilotinib (Tasigna®) in combination with other chemotherapeutic drugs.
Treatment for Central Nervous System Involvement
ALL sometimes spreads to the central nervous system, which is the part of the nervous system that consists of the brain and the spinal cord. Physicians treat most patients to prevent or control central nervous system involvement and may administer chemotherapy directly to the fluid that bathes the spinal cord and brain in a process known as intrathecal chemotherapy. Patients may receive high-dose systemic chemotherapy or cranial irradiation (radiation therapy to the head) to prevent the spread of disease to the central nervous system.
Bone Marrow Transplant
For some patients with ALL, a bone marrow or stem cell transplant may be part of the treatment plan. Learn more about blood and marrow stem cell transplantation.
Researchers at Memorial Sloan-Kettering continue to develop new agents for cancer treatment, and to test new treatment approaches in our clinical trials. Relying, in part, on the information that is emerging about the genetic basis of leukemia, investigators are pursuing a variety of strategies to control the disease — approaches that can kill tumor cells directly, inhibit the body's production of substances that promote their growth, or enhance the immune response against leukemic cells.
- Cancer Genetics
Researchers here are studying the chromosomal abnormalities in patients with untreated ALL to better predict how patients with particular genetic attributes will respond to treatment. The results could help them link specific karyotypes (the number and structure of chromosomes in an individual) with multidrug resistance, help identify new chromosome abnormalities that play a role in the development of leukemia, and correlate specific genetic abnormalities with toxic exposures and family histories.
- New Combination Chemotherapy
Drugs used in chemotherapy work in different ways to stop tumor cells from dividing and to cause them to die. Physicians usually combine two or more agents in a course of treatment in an effort to kill as many tumor cells as possible. Investigators at Memorial Sloan-Kettering are comparing the effectiveness of various combinations of chemotherapeutic agents.
- Engineered T Cells
Researchers at Memorial Sloan-Kettering are working to produce T cells, a form of white blood cell, that will recognize and attack a patient's cancer cells. To do this, they extract some of the patient's own T cells, introduce a gene that enables these cells to recognize a protein on the surface of the leukemia cells, and grow these cells in culture before giving them back to the patient. The modified T cells, now able to recognize the antigens as foreign, should divide and multiply until they reach numbers that can have an impact on the tumor cells. Investigators then administer the “engineered” T cells back into the patient so that they will seek out and destroy the cancer cells.