To get the best treatment outcome, it helps to see a hematologist-oncologist who has experience treating ALL, advises the Leukemia & Lymphoma Society. You might also want to get a second opinion to make sure you’re comfortable with the treatment your doctor recommends.
Leukemia treatment is personalized. Your doctor will tailor the treatment to you on the basis of your age, health, and type of ALL.
Chemotherapy kills cancer cells all over your body. Often it’s the main treatment for ALL, says the American Cancer Society. The treatment lasts for about two years, and depending on your ALL type, it can be intense.
Chemotherapy for ALL comes in three phases.
Induction This first phase usually lasts about one month. The goal is to kill as many cancer cells as needed to put your cancer into remission — where there are no signs of cancer in your bone marrow and your blood cell counts are normal.
If you have the Philadelphia chromosome, you might also get a targeted drug such as dasatinib (Sprycel) or imatinib (Gleevac). This type of treatment targets specific proteins and other substances that make the cancer grow.
During this phase, you may also get chemotherapy injected directly into the cerebrospinal fluid that surrounds your brain and spinal cord, or radiation therapy to your brain and spinal cord. This is done to kill any cancer cells that might have spread to your nervous system.
Consolidation Once your cancer is in remission, you’ll get more chemotherapy for a few months to kill any cancer cells that might have been left behind. The goal is to prevent your cancer from relapsing. You might get the same medicines you received in the first phase, or different chemotherapy drugs.
Maintenance The final phase of treatment lasts for about two years, says the American Cancer Society. You’ll get lower doses of chemotherapy drugs over a longer period of time to prevent your cancer from relapsing.
If you can’t tolerate chemotherapy or your cancer comes back after chemo, you might get one or more of these other treatments.
Radiation therapy High-energy X-rays are used to kill cancer cells. It may be used to treat ALL that has spread to the brain and spinal cord.
Targeted therapy Medicines called tyrosine kinase inhibitors (TKIs) attack a substance that helps certain ALL cells grow. This therapy is used for people with the Philadelphia chromosome.
Immunotherapy These drugs help your immune system more effectively kill cancer cells. These are some of the immunotherapy drugs used to treat ALL, according the American Cancer Society.
- Blinatumomab (Blincyto) This is a special kind of antibody that pulls the cancer cells and your immune cells together so your immune system can attack the cancer. This medicine comes as an infusion that you get through a vein over a 28-day period. Because this treatment can cause serious side effects, you’ll need to stay in a hospital to be monitored during the first few infusions.
- Inotuzumab ozogamicin (Besponsa) This is a type of medicine called an antibody-drug conjugate. Some leukemia drugs have the CD22 protein on their surface. Besponsa contains an antibody to CD22 attached to a chemotherapy drug. The antibody carries the chemotherapy to leukemia cells.
- Chimeric antigen receptor (CAR) T-cell therapy With this treatment, your own immune cells (your T-cells) are altered in a lab so they can find and attack cancer cells. The two FDA-approved CAR T-cell therapies for ALL are tisagenlecleucel (Kymriah) and brexucabtagene autoleucel (Tecartus).
Stem cell transplant The cancer cells in your bone marrow are destroyed using high-dose chemotherapy. Because the chemo also wipes out healthy blood cells, you’ll get an infusion of healthy stem cells to replace the ones that were destroyed. The stem cells can come from your own body or from a healthy donor. A stem cell transplant is very intense therapy with potentially severe side effects like graft-versus-host disease. Your doctor will make sure you’re a good candidate and you’re healthy enough before recommending this treatment.
Clinical trials are studies that test the safety and effectiveness of new ALL medications and drug combinations. Enrolling in one of these studies could give you access to a cutting-edge therapy before it’s available to the public. What researchers learn from clinical trials helps future generations of people with ALL.
If you’re interested in joining a clinical trial, ask your hematologist-oncologist if any ALL studies are a good fit for you.