ALL is classified as:
Untreated. Untreated ALL is newly diagnosed.
In remission. ALL that is in remission has been treated. The patient does not currently have any signs or symptoms of leukemia.
Recurrent. Recurrent ALL has been treated. It has come back after going into remission.
There are usually two phases of treatment for adult ALL. The goal of the first treatment phase is to kill as many leukemia cells in the blood and bone marrow as possible. This puts the disease into remission. The goal of the second phase is to kill any remaining leukemia cells that may not be active but which could begin to regrow and cause a relapse. The total treatment can take two or three years.
During these phases, patients also receive therapy to prevent or treat leukemia in the brain and spinal cord.
The major standard therapy for ALL is chemotherapy. Chemotherapy for ALL is usually given as combination chemotherapy. This means that more than one anticancer drug is used. Other treatments may be used under different circumstances.
Following are some of the commonly used treatments for ALL:
Chemotherapy uses drugs to stop the growth of cancer cells by killing them or keeping them from dividing. Chemotherapy drugs may be taken by mouth or injected into a vein or muscle. They travel through the bloodstream and body. Chemotherapy that goes directly into the spinal column may be used to treat ALL that has, or may, spread to the brain and spinal cord.
Radiation therapy uses high-energy radiation to kill cancer cells or stop them from growing. The radiation can be delivered from a machine outside the body (external radiation therapy). Or, it can come from a radioactive substance placed in or near a local collection of cancer cells.
Tyrosine kinase inhibitor therapy blocks an enzyme that causes the development of too many white blood cells in the body. Imatinib (Gleevec) and dasatinib (Sprycel) are two examples of these drugs.
The cancer drug, vincristine, has been the main chemotherapy used for ALL in adults. A new form of vincristine allows more of the drug to be administered. It's prescribed for people with certain types of ALL that have had an incomplete response to other therapies.
A more recent treatment for ALL is a stem cell transplant. A stem cell transplant replaces a person's blood-forming cells. Stem cell transplants can use stem cells from your own body or from a donor. Donor stem cell transplant may be necessary if the patient's own stem cells are abnormal or have been destroyed by cancer treatment.
Stem cells (immature blood cells) are removed from the blood or bone marrow of a patient or donor. Once removed, they are examined under a microscope and the cell number is counted. The stem cells are stored for future use.
The patient then undergoes high-dose chemotherapy to eradicate the leukemic cells that populate the bone marrow. The stored stem cells are then infused into the patient's bloodstream. They migrate into the bone marrow space. Because these are stem cells, they are able to regenerate and grow into the many different cells that normally populate the bone marrow.
Stem cell transplants require very high dose chemotherapy to rid the body of all the leukemia. In the process, the patient cannot make any blood cells until the stem cells have had time to mature. This puts the patient at high risk of infection and bleeding. In addition to the short term risks, there are also long term side effects. Stem cell transplants should be undertaken only in specialized centers.
Patients who have finished treatment should continue to see their doctors regularly for checkups. Some of the tests done to diagnose ALL may be repeated during and after treatment to see how well the therapy is working and/or whether your condition has changed.
Some people receiving ALL treatment may experience no side effects. Others may face short-term or long-lasting side effects. Among the possible side effects of treatment are:
nausea and vomiting
nerve damage causing pins and needles sensations in the feet and hands
There are many ways to manage these side effects. For example, regular hand washing can help lower the risk of infection.
When considering a treatment option, it's important to ask your doctor about the expected benefits and risks of a particular therapy. How will this treatment affect my prognosis? What will my quality of life be during and after treatment?