(From left) Investigators Isabelle Rivière, Michel Sadelain, and Renier Brentjens are collaborate on immunotherapy approaches that have been particularly effective for patients with B cell ALL that resisted treatment or come back after treatment.
The standard treatment approaches for acute lymphocytic leukemia include chemotherapy and sometimes bone marrow transplantation. However, your Memorial Sloan Kettering doctor will develop a treatment plan that takes a number of factors into account, including the ALL subtype, the number of leukemia cells in the blood, and chromosomal changes. For this reason ALL patients with the same subtype may receive different treatments.
Standard upfront treatment for ALL is typically divided into several phases: induction, intensification, consolidation, and maintenance.
During the induction phase, your doctors work to induce a remission — a state in which there is no visible evidence of disease and blood counts are normal. They may recommend a combination of drugs including vincristine, corticosteroids, L-asparaginase, doxorubicin, daunorubicin, or cyclophosphamide. Treatment can last up to four weeks, and you will need to be hospitalized during induction therapy.
More recently, our doctors developed an induction regimen based on an innovative approach used for pediatric patients that includes greater use of vincristine, corticosteroids, and L-asparaginase. This new strategy appears to be potentially more effective than many of the existing standard therapies for adults and is available as part of a clinical trial.
During the intensification and consolidation phases, a secondary treatment is given to kill any cancer cells that may be left in the body. This phase may last several months and typically consists of additional chemotherapy. If recommended, bone marrow transplantation may also be performed at this time.
During the maintenance phase, you 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. Our doctors commonly use methotrexate, 6-mercaptopurine, vincristine, and prednisone during the maintenance phase.
Treatment for Ph-Positive ALL
Our researchers were instrumental in the development of treatments for these patients, which include imatinib (Gleevec®) and related drugs, such as dasatinib (Sprycel®) or nilotinib (Tasigna®) in combination with other chemotherapy 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. Our doctors are experienced in preventing or controlling 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.
Our researchers are constantly pursuing new approaches to treat ALL — 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. See an up-to-date listing of our clinical trials.
Newer combination chemotherapy approaches inspired by innovative treatments developed for pediatric patients are potentially more effective than existing standard therapies for adults. Our researchers are leading clinical trials incorporating these approaches into upfront treatment.
Immunotherapy has produced very encouraging results in patients with B cell acute lymphoblastic leukemia that has come back after or been resistant to standard therapy. Our researchers are pioneers in this field, working to engineer T cells, a form of white blood cell, that can recognize and attack a patient’s cancer cells.
Our researchers are studying new therapies that target genes that are commonly mutated in particular subtypes of ALL, such as NOTCH1 in T cell ALL. Also, by performing comprehensive characterization of chromosome abnormalities and gene mutations of each case, our researchers aim to identify abnormalities that may allow for the development of new targeted therapies.