There is more than one treatment for ALL. Not everyone will receive the same treatment. Treatment options are based on many factors. Together, you and your doctor will choose a treatment plan that is right for you.
Chemotherapy is the backbone of ALL treatment and is often combined with other drug therapies. Chemotherapy is a type of systemic drug therapy that kills fast-growing cells throughout the body, including cancer cells and normal cells.
Chemotherapy can be given as follows:
- Oral (PO) – taken by mouth either as a liquid or pill
- Subcutaneous (SQ) – given under the skin
- Intramuscular (IM) – uses a needle to inject medicine in the muscle of the arm or leg (like the flu shot)
- IV (intravenous) infusion – chemotherapy administered through a vein using IV push, gravity infusion, or infusion pump. In an IV push, a drug is injected quickly over a few minutes. With a gravity infusion, medicine is put into a bag that hangs on a pole, and the pressure of gravity delivers the medicine into the IV line at a safe and steady rate. In an IV infusion, chemotherapy flows through a tube attached to the catheter. The flow may be controlled by a machine called an IV pump.
- Intrathecal (IT) – chemotherapy administered into the spinal fluid. In addition to other forms of chemotherapy, you will have chemotherapy injected into the cerebrospinal fluid (CSF) to kill any leukemia cells that might have spread to the brain and spinal cord. This treatment is given through a lumbar puncture (spinal tap).
Chemotherapy consists of remission induction, consolidation phases and maintenance. Maintenance chemotherapy continues for 2 years.
Steroid is the short name for corticosteroid. Steroids are man-made versions of hormones made by the adrenal glands. The adrenal glands are small structures found near the kidneys, which help regulate blood pressure and reduce inflammation. Steroids also are toxic to lymphoid cells and are an important part of ALL chemotherapy. Steroids can cause short-term and long-term side effects.
Targeted therapy is a form of systemic therapy that works throughout your body. It is a drug therapy that focuses on specific or unique features of cancer cells. Targeted therapies seek out how cancer cells grow, divide, and move in the body. These drugs stop the action of molecules that help cancer cells grow and/or survive.
Immunotherapy is a targeted therapy that increases the activity of your immune system and also kills the leukemic cells. By doing so, it improves your body’s ability to find and destroy cancer cells. Immunotherapy can be given alone or with other types of treatment. Immunotherapies are sometimes used for relapsed/refractory disease. Blinatumumab or inotuzumab are given often as immunotherapy.
Radiation therapy (RT) uses high-energy radiation from x-rays, gamma rays, protons, and other sources to kill cancer cells and shrink tumors. It is given over a certain period of time. Radiation therapy can be given alone or with certain systemic therapies. Those with leukemia in the central nervous system at diagnosis may receive radiation to the brain area beside intratechal chemotherapy. Those with testicular disease at diagnosis that remains after induction therapy may receive radiation to the testes.
Cranial irradiation and Total body irradiation
In cranial irradiation, the areas of the brain targeted for ALL radiation treatment are different from areas targeted for brain metastases of solid tumors. Cranial irradiation might be given to prevent ALL from spreading to the brain. This is called prophylaxis. Total body irradiation (TBI) is radiation of the whole body given before bone marrow transplant.
Stem cell transplant (Bone marrow transplant- BMT)
There are 2 types of BMTs:
- Autologous – stem cells come from you
- Allogeneic – stem cells come from a donor who may or may not be related to you
Only an allogeneic BMT is used as a treatment option for ALL. A bone marrow transplantation depends upon donor availability and your health at the time of potential BMT.
After conditioning, you will receive the healthy stem cells through a transfusion. A transfusion is a slow injection of blood products into a vein. This can take several hours. The transplanted stem cells will travel to your bone marrow and grow. New, healthy blood cells will form. This is called engraftment. It usually takes about 2 to 4 weeks. Until then, you will have little or no immune defense. You may need to stay in a very clean room at the hospital or be given antibiotics to prevent or treat infection. Transfusions are also possible. A red blood cell transfusion is used to prevent bleeding and to treat anemia (below normal red blood cell count). A platelet transfusion is used to treat a low platelet count or bleeding.