The standard treatments for adult-onset acute lymphocytic leukemia (ALL) are chemotherapy and stem cell (bone marrow) transplantation. Depending on the features of the disease, you may also be able to receive a kind of immunotherapy in which your own immune cells are engineered to seek out and destroy the cancer, called CAR T cell therapy.
At Memorial Sloan Kettering, we will develop a treatment plan especially for you. This plan will take a number of factors into account. These include the disease’s subtype, the number of leukemia cells in your blood, and chromosomal changes.
The standard upfront treatment for ALL is usually divided into three phases: induction, intensification and consolidation, and maintenance.
During the induction phase, our doctors aim to induce a remission. This means there is no visible evidence of disease and your blood counts are normal. We may recommend a combination of drugs. These drugs include:
- vincristine (Oncovin®, Vincasar® PFS, Vincrex®)
- L-asparaginase (Elspar®, Kidrolase®)
- doxorubicin (Adriamycin®, Rubex®)
- daunorubicin (Cerubidine®)
- cyclophosphamide (Cytoxan®)
Treatment can last up to four weeks. You will need to stay in the hospital during this part of your treatment.
Our doctors and scientists have developed an induction regimen for adults based on an approach used for children with ALL. It uses more vincristine, corticosteroids, and L-asparaginase. This strategy appears to be more effective than many of the existing therapies for adults. It is available as part of a clinical trial.
A secondary treatment is given to kill any cancer cells that may be left in your body during the intensification and consolidation phase. This phase typically consists of additional chemotherapy. It may last several months. You may also receive a stem cell transplant at this time.
During the maintenance phase, you may receive lower doses of drugs but for long periods of time, typically two years. This will destroy any remaining leukemia cells. These cells are usually not detectable by laboratory tests. Our doctors commonly use methotrexate (Rheumatrex®, Trexall®), 6-mercaptopurine (Purinethol®), vincristine, and prednisone (Cortan®, Deltasone®, Orasone®, Sterapred®) during the maintenance phase.
CAR T Cell Therapy
CAR T cell therapy is an exciting and powerful new treatment for certain people up to age 25 whose ALL has stopped responding to other therapies. CAR T cells are sometimes called “living drugs.” That’s because the treatment uses your own cells to treat the cancer. With CAR T therapy, your immune cells are filtered from your blood. Then they are sent to a lab, where they are armed with new proteins that teach them to recognize cancer. Afterward, your newly supercharged cells are multiplied and infused back into your blood, where they can seek out and destroy the cancer.
Memorial Sloan Kettering is one of only a select few institutions equipped to administer CAR T cell therapy safely. Our doctors and nurses have unparalleled expertise in caring for people who are receiving this treatment. Our clinical staff, including our Bone Marrow Transplant Service, has vast experience in minimizing risks and managing side effects. Memorial Sloan Kettering scientists played a pioneering role in developing the science and technology of CAR T cell therapy. We are researching how to make it work better and work for more people.
Treatment for Ph-Positive ALL
If you have been diagnosed with Philadelphia-positive ALL (Ph-Positive ALL), you may receive certain targeted therapies that have proven particularly effective against this subtype of the disease. Our researchers were instrumental in the development these treatments. These drugs include imatinib (Gleevec®), 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 consists of your brain and spinal cord. Our doctors are experienced in preventing or controlling central nervous system involvement. We may administer chemotherapy directly to the fluid around the spinal cord and brain. This procedure is called intrathecal chemotherapy. You may receive high-dose systemic chemotherapy or cranial irradiation (radiation therapy to the brain). These can prevent the spread of the disease to the central nervous system.
Our researchers are constantly pursuing new ways to treat ALL. These approaches can kill tumor cells directly, slow down the body’s production of substances that promote their growth, or enhance the immune response against the leukemia cells.
Some of the newer combination chemotherapy approaches that we’re evaluating in adults are inspired by innovative treatments developed for children with ALL. These treatments may be more effective than existing standard therapies. Our researchers are leading clinical trials incorporating these new approaches into treatment from the time you are first diagnosed.
Our researchers are also studying new therapies that target common genetic changes in some subtypes of ALL. We look for chromosome abnormalities and gene mutations in everyone with ALL whom we care for. We are working diligently to identify genetic changes that may help in creating new targeted therapies.