Key takeaways

  • Treatment for Acute Lymphocytic Leukemia (ALL) primarily involves chemotherapy, divided into three phases: induction (to achieve remission), consolidation (to eliminate remaining cancer cells), and maintenance (to prevent relapse).
  • Additional treatments may include radiation therapy, especially if ALL has spread to specific areas, or if preparing for a stem cell transplant, which involves replacing damaged bone marrow with healthy donor cells.
  • When traditional chemotherapy is not fully effective, targeted therapies and immunotherapy can be used. These therapies focus on specific aspects of cancer cells or boost the body’s immune response to fight the leukemia.

Acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia, is a type of fast-growing bone marrow cancer originating in white blood cells called lymphocytes.

The type of ALL you’re diagnosed with depends on the primary lymphocytes involved, B cells or T cells, and their genetic features.

ALL is not a common cancer, but it’s the most common childhood cancer, and anyone of any age can develop this condition.

Treatment for ALL typically focuses on several phases of chemotherapy but can vary depending on your individual needs and diagnosis.

Chemotherapy is the cornerstone of ALL treatment. Chemotherapy drugs target rapidly growing cells in your body to control cancer’s growth and spread.

Your chemotherapy plan involves three phases:

  • induction
  • consolidation
  • maintenance

Common chemotherapy drugs that may be given during these phases include:

  • vincristine
  • daunorubicin
  • doxorubicin
  • cytarabine
  • L-asparaginase
  • methotrexate
  • nelarabine
  • 6-mercaptopurine
  • cyclophosphamide

Your doctor may also include a corticosteroid, like prednisone or dexamethasone, as a part of your chemotherapy protocol.

Induction

The induction phase focuses on eliminating clinical signs and symptoms of cancer, or what’s known as complete remission. The goal is complete remission, but it can be partial.

During this phase, chemotherapy drugs are used to get rid of as many cancer cells as possible.

Your doctor also initiates central nervous system (CNS) prophylaxis or treatment. This chemotherapy aims to prevent ALL from spreading to the CNS or to treat ALL already affecting the brain and spinal cord.

The induction phase lasts approximately 4 weeks.

Consolidation

When you’ve achieved complete remission, your doctor moves you into the consolidation phase to eliminate ALL cells that might not be detectable.

Your CNS treatment is continued, and chemotherapy drugs are increased to root out cancer that might be lingering.

Consolidation can last several months and may include additional therapies relevant to your specific diagnosis. Targeted therapies and immunotherapy might be added depending on the genetic features of ALL cells or your individual treatment response.

Maintenance

The maintenance phase of chemotherapy for ALL generally lasts about 2 years. Its purpose is to prevent relapse and to keep any remaining ALL cells controlled for the long term.

Current chemotherapy typically involves oral medications taken at home.

CNS treatment or prophylaxis is continued throughout all three phases of chemotherapy.

Radiation therapy uses high-powered radiation to kill cancer cells. It’s not usually part of the first-line treatments for ALL, but doctors recommend it in certain circumstances.

Radiation can be administered as a whole-body therapy or through external beam radiation, which uses a beam of radiation from a machine to target specific sites in the body.

Your ALL treatment may include radiation if:

  • ALL has spread to the CNS or testicles
  • you’re being prepped for a stem cell transplant
  • bone pain is severe and not improving with chemotherapy
  • ALL has caused a tumor-like mass in the chest, constricting airways or blood vessels

For some people at high risk for ALL to return after treatment or with other less favorable prognostic factors, an allogeneic stem cell transplant may be an option during the consolidation phase of chemotherapy.

Allogeneic stem cell transplant involves transplanting stem cells from a donor into your body so they can help rebuild your population of healthy blood cells.

If you’re a candidate for allogeneic stem cell transplant, you may receive radiation therapy first to eliminate as many cancer cells as possible before introducing healthy donor cells.

Targeted therapies “target” specific moments in cancer’s development or spread. These medications disrupt processes important to cancer’s survival.

They’re used when traditional chemotherapy isn’t effective on its own or when ALL cells have certain genetic features, like the Philadelphia chromosome.

Tyrosine kinase inhibitors (TKIs) are targeted therapies that focus on specific enzymes called tyrosine kinases, which are essential to pathways regulating cell growth. TKIs block tyrosine kinases, preventing their growth and multiplication.

Commonly used TKIs in ALL include:

  • imatinib
  • nilotinib
  • dasatinib
  • bosutinib
  • ponatinib

Immunotherapies modify or enhance your immune system’s response to cancer cells. Some immunotherapies, like monoclonal antibodies, are also considered targeted therapies because they affect specific molecular sites called antigens on cells.

Monoclonal antibodies

Many different classes of monoclonal antibodies exist, differentiated by their cellular targets and how they destroy cancer cells.

Blinatumomab, for example, is a bispecific T-cell engager (BiTE) monoclonal antibody used in ALL. Blinatumomab may be used when traditional chemotherapy doesn’t work for ALL that is negative for the Philadelphia chromosome.

One part of it binds to the CD19 antigen site on cancerous B cells, and the other part binds to CD3 on your immune system’s T cells. The monoclonal antibody helps bring the T cell to the B cell to destroy it.

Another monoclonal antibody used in ALL is inotuzumab ozogamicin. This drug is a type of antibody-drug conjugate (ADC) that targets CD22 on cancerous B cells and delivers a toxin that kills the cell when it starts to divide.

CAR T-cell therapy

Chimeric antigen receptor (CAR) T-cell therapy uses your natural T cells to fight ALL. T cells are removed from your blood and genetically modified with specific receptor sites (CARs) on their surface. The modified T cells bind to antigens on ALL cells.

Current CAR T-cell medications used in ALL include:

  • brexucabtagene autoleucel
  • tisgenlecleucel

Other immunotherapies

Immunotherapies are an area of ongoing research in ALL. Other immunotherapies being explored for use include:

  • immune checkpoint inhibitors
  • adoptive T-cell transfer (non-CAR T-cell therapy)
  • natural killer (NK) cell therapy
  • novel antibody-drug conjugates (ADCs)

Clinical trials are how experts determine the safety, efficacy, and application of emerging therapies. These volunteer-based studies can provide you with the opportunity to receive innovative ALL treatments under the direction of a highly specialized and qualified medical team.

A clinical trial may be a good option if you’re experiencing refractory (treatment-resistant) ALL or if you’ve been given a less favorable outlook with traditional therapies.

You can access current clinical trials for ALL by visiting:

The American Cancer Society indicates the overall cure rate for ALL is around 40% with traditional treatments. Most people achieve complete remission at some point, but relapse is common.

Success rates can vary based on factors like your age, ALL’s genetic features, and your treatment response.

For approximately 10% to 20% of people, ALL is refractory and requires second-line treatments like targeted therapies, immunotherapy, or stem cell transplant in addition to chemotherapy.

Overall, the 5-year survival rate in ALL is around 90% for children, with adult survival rates between 20% and 40%.

ALL is a fast-growing type of bone marrow cancer that’s typically treated with chemotherapy. Doctors take you through a 3-phase treatment course that focuses on eliminating cancer cells and achieving remission.

ALL may require second-line treatments like targeted therapies, immunotherapy, radiation, or stem cell transplant. This is likely if ALL is treatment-resistant, accompanied by less favorable prognostic factors, or certain genetic features are present.