Treatment options and prognosis for acute lymphoblastic leukemia (ALL) depend on the ALL subtype and classification, as well as your age, underlying health, and whether the disease has spread to the brain or spinal fluid. Given the highly complex and intensive treatment protocols for ALL, it is important to be treated at a specialized center with expertise in ALL. Seattle Cancer Care Alliance (SCCA) experts offer comprehensive ALL care, including advanced treatments and new options available only through clinical studies.
The main types of treatment for ALL are:
- Targeted therapy
- Bone marrow transplant
The goal of therapy is remission—absence of leukemic cells in the bone marrow, return of normal marrow cells, and normal blood counts. Special consideration is given to people with ALL who are elderly or frail; these patients are often treated with less aggressive regimens.
Phases of Treatment
ALL treatment is generally done in phases.
- Induction therapy
- Consolidation therapy
- Maintenance therapy
Depending on the treatment plan, the phases may be combined.
Because the disease progresses quickly, induction therapy often starts soon after diagnosis. This course of treatment typically includes multi-agent chemotherapy—a combination of several chemotherapy drugs—given with a steroid, such as prednisone or dexamethasone. In addition to these drugs, people with Philadelphia chromosome-positive ALL (PH+ ALL) are treated with an oral drug that targets the BCR-ABL gene (targeted therapy). Initial treatment is often intense. It is typically given in the hospital over several days, and you may need to stay in the hospital for a week or more depending on how you tolerate the treatment.
The good news is that about 80 percent of newly diagnosed cases of ALL enter remission after induction therapy. However, treatment is not over at that point. Depending on certain factors, such as the ALL subtype, doctors may recommend you have continuing chemotherapy—consolidation and maintenance therapy, described below—or a bone marrow transplant. The goal is to offer the safest and most effective way of keeping your disease in remission for as long as possible, hopefully forever.
For people whose leukemia does not respond to treatment (refractory disease) or whose leukemia comes back after being in remission (disease relapse), doctors may suggest a different treatment regimen or a bone marrow transplant to try to achieve remission.
Without additional treatment after induction therapy, people who’ve gone into remission may experience a relapse. Consolidation therapy is meant to prevent this. It usually lasts a few weeks to a few months and consists of treatment with multi-agent chemotherapy, steroids, and targeted therapy. Often, the treatments given in this phase of therapy are similar to but slightly different from those given during the induction phase.
Patients who are in remission may continue on maintenance therapy or they may go on to a bone marrow transplant to ensure their disease stays in remission.
After induction and consolidation therapy, most patients in remission go on maintenance (or continuation) therapy to help lower the risk of a recurrence. This treatment, which may last for a few years, usually consists of lower doses of drugs, such as multi-agent chemotherapy and targeted therapies. While you may experience side effects from maintenance therapy, this part of the treatment is typically easier than the induction and consolidation phases.
Treating ALL in the Central Nervous System
People with ALL are treated for cancer that may spread to the brain and spinal cord (central nervous system, or CNS). This treatment, known as CNS prophylaxis, is generally used during all phases of treatment for ALL. CNS prophylaxis is usually included as part of the multi-agent chemotherapy, but sometimes it may be radiation therapy targeted at the CNS or chemotherapy injected directly into the cerebrospinal fluid (intrathecal chemotherapy).
Occasionally, ALL is present in the CNS at the time it is initially diagnosed. In this case, the treatment is similar to what is described for CNS prophylaxis; however, the number of treatments to the CNS is often higher to clear this part of the body of any signs of the leukemia.
Access to clinical studies conducted by researchers at SCCA founding organizations—Fred Hutch, UW Medicine, and Seattle Children’s—is one reason why many patients come to SCCA for treatment. The goal of clinical studies, also known as clinical trials, is to develop more effective lifesaving treatments in the fight against leukemia. Immunotherapy—treatment that exploits the patient’s own immune system to recognize and attack cancer cells—is a promising new approach being studied in clinical trials for the treatment of ALL. Other areas of research include testing new chemotherapy medications and new ways to deliver them more effectively.
For some patients, taking part in a clinical study may be the best treatment choice. At any time, SCCA has studies ongoing that are evaluating new treatments for ALL. Be sure to ask your doctor if a clinical study is right for you. For more information about participating, see our patient guide to clinical studies.