Chemotherapy is the primary treatment for acute lymphoblastic leukemia (ALL). One of the distinguishing characteristics of acute leukemia cells is the high rate at which they grow and multiply, which makes them susceptible to chemotherapy drugs.
What Chemotherapy Does
Most chemotherapy is systemic; it enters your bloodstream and goes throughout your body. The drugs target and destroy quickly dividing cells—this includes cancer cells as well as certain normal cells, such as hair follicles, cells in the lining of your mouth and intestines, and healthy bone marrow stem cells, which is why chemotherapy may lead to side effects.
Chemotherapy injected directly into the cerebrospinal fluid (intrathecal chemotherapy) is used to treat cancer that may have spread to the brain and spinal cord. When chemotherapy is given this way—to a specific area of the body—it is regional chemotherapy, and the drugs mainly affect cancer cells in the area of the body where the drug is given.
Chemotherapy drugs may be used alone, but for ALL doctors usually give multi-agent chemotherapy—a combination of several chemotherapy drugs.
Getting Chemotherapy for ALL
How often you get treatment and how long your treatment lasts depend on the subtype and classification of your cancer, the drug or combination of drugs selected, and your body’s response to treatment. You may get treatments weekly, every two to three weeks, or monthly. Chemotherapy is generally given in cycles, meaning the treatment is repeated on a routine basis.
Most chemotherapy drugs for ALL are given by infusion through an intravenous (IV) line. The kinds of chemotherapy used to treat ALL are best given through a port or other device that delivers the medication directly into a vein in the chest. Some chemotherapy can be given through an IV line in the hand or arm, some may be given by injection into the muscle or just below the skin, while others can be taken by mouth in pill form.
Some of the drugs most commonly used to treat ALL include:
- Cyclophosphamide (Clafen, Cytoxan, Neosar)
- Cytarabine (Cytosar-U, Tarabine)
- Doxorubicin (Adriamycin) or daunorubicin (Cerubidine, Rubidomycin)
- Mercaptopurine (Purinethol, Purixan)
- Methotrexate (Abitrexate, Folex, Mexate)
- Nelarabine (Arranon)
- Pegaspargase (Oncaspar)
- Vincristine (Vincasar) or liposomal vincristine (Marqibo)
Side Effects of Chemotherapy
Side effects of chemotherapy vary greatly from person to person and depend on the type and dose of drugs given, the way they are given, and the length of time they are given. Your treatment team can tell you about the side effects that are most common with your drugs.
Some of the side effects of chemotherapy may include:
- Anemia (related to low red blood cell count)
- Infection (related to low white blood cell count)
- Bleeding (related to low platelet count)
- Hair loss
- Loss of appetite
- Nausea and vomiting
- Diarrhea or constipation
- Mouth sores (mucositis)
- Numbness in fingers and toes (neuropathy)
Some people who have a lot of leukemic cells may experience tumor lysis syndrome when they are first treated with chemotherapy. This syndrome is caused by the breakdown of large numbers of tumor cells, which release substances into the bloodstream that may damage the kidneys, heart, and liver. Doctors that specialize in treating leukemia are well aware of this potential complication and have methods to reduce the risk.
Let your team know about any side effects you experience. They may be able to give you medicines to prevent or relieve side effects, suggest other ways to manage side effects, or change your chemotherapy dosage or treatment schedule to prevent side effects from getting worse. For general advice, see the section on coping with side effects.
The time it takes to get over some side effects and regain energy depends on many factors, including your overall health and the drugs you were given. Many side effects are short term and go away after treatment is finished because your healthy cells recover over time. In a small percentage of people, less than 5 percent, a potential late effect of chemotherapy treatment for ALL is an increased risk of developing a secondary cancer (like a different form of leukemia called acute myeloid leukemia).