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Treatments and drugs
By Mayo Clinic staffIn general, treatment for acute lymphocytic leukemia falls into separate phases:
- Induction therapy. The purpose of the first phase of treatment is to kill most of the leukemia cells in the blood and bone marrow.
- Consolidation therapy. Also called post-remission therapy, this phase of treatment is aimed at destroying the leukemia cells remaining in the brain or spinal cord.
- Maintenance therapy. The third phase of treatment prevents leukemia cells from regrowing. The treatments used in this stage are often given at much lower doses.
- Preventive treatment to the spinal cord. People with acute lymphocytic leukemia may also receive treatment to kill leukemia cells hiding in the central nervous system during each phase of therapy. In this type of treatment, chemotherapy drugs are injected directly into the fluid that covers the spinal cord. This kills cancer cells that can't be reached by chemotherapy drugs given by mouth or through an intravenous line.
The phases of treatment typically take two and a half to three and a half years. Treatments may include:
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Chemotherapy. Chemotherapy, which uses drugs to kill cancer cells, is the most common form of induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy induction therapy typically requires an extended hospital stay because the drugs destroy many normal blood cells in the process of killing leukemia cells. This can cause anemia, infection and bleeding.
Chemotherapy drugs can also be used in the consolidation and maintenance phases, but these phases are usually less intensive regimens and don't require staying in the hospital.
- Targeted drug therapy. Targeted drugs attack specific abnormalities present in cancer cells that help them grow and thrive. One targeted drug, imatinib (Gleevec), specifically attacks cancer cells that have a certain abnormality called the Philadelphia chromosome. The drug dasatinib (Sprycel) works in a similar way. These drugs are only approved for people with the Philadelphia chromosome-positive form of ALL. Another drug, rituximab (Rituxan), targets cancer cells that have an overabundance of a certain protein. Targeted drug treatments may be combined with chemotherapy drugs.
- Radiation therapy. Radiation therapy uses high-powered beams, such as X-rays, to kill cancer cells. If the cancer cells have spread to the central nervous system, your doctor may recommend radiation therapy.
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Bone marrow stem cell transplant. A bone marrow stem cell transplant may be used as consolidation therapy in people at high risk of relapse or for treating relapse when it occurs. This procedure allows someone with leukemia to re-establish healthy stem cells by replacing leukemic bone marrow with leukemia-free marrow.
A bone marrow stem cell transplant begins with high doses of chemotherapy or radiation to destroy any leukemia-producing bone marrow. The marrow is then replaced by bone marrow from a compatible donor (allogeneic transplant). In some cases, people are able to use their own bone marrow for transplantation (autologous transplant). This may be possible if you or your child goes into remission and healthy bone marrow is then harvested for a future transplant.
- Clinical trials. Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, they can't guarantee a cure. Discuss the benefits and risks of clinical trials with your doctor.
