Acute lymphoblastic leukemia

Treatment

Treatment for acute lymphoblastic leukemia (ALL) is highly complex and intensive, so it’s important to be treated at a specialized center with expertise in ALL. But because the condition is rare, many hospitals and clinics do not have much experience with it.

Seattle Cancer Care Alliance (SCCA) experts offer comprehensive ALL care, including advanced treatments and new options available only through clinical studies.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

ALL expertise at SCCA

Everything you need is here

We have medical oncologists and hematologists who specialize in ALL; the most advanced diagnostic, treatment and recovery programs; and extensive support.

Innovative leukemia therapies

SCCA is a world leader in leukemia research. Our doctors and scientists pioneered a very important leukemia treatment — bone marrow transplant — and we advance new therapies every day. 

ALL treatment tailored to you

We view treatment as a collaborative effort. Your SCCA doctor will explain all your options and recommend a treatment plan based on your ALL subtype and classification, health, lifestyle and preferences.

Team-based approach

Your personal team includes an oncologist, nurse case manager and team coordinator. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like an infectious disease doctor, pulmonologist, palliative care professional, geneticist, social worker, physical therapist or dietitian. 

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Ongoing care and support

After treatment, your team continues to provide follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life as an ALL survivor.

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Dr. Ryan Cassaday explains a range of ALL treatment approaches and why the disease is often treated in three phases.

Treatment types

Phases of ALL treatment

Phase 1: ALL induction therapy

Because ALL progresses quickly, intense treatment to put the disease in remission often starts soon after diagnosis. This typically means getting a combination of chemotherapy drugs along with a steroid in the hospital over several days. If you have Philadelphia chromosome-positive ALL (PH+ ALL) you’ll also receive a drug that targets the BCR-ABL gene. 

Your inpatient care will be at the SCCA inpatient hospital at University of Washington Medical Center. The medical center was named a Magnet hospital for its outstanding nursing care. Research shows patient outcomes are better at Magnet hospitals.

We know people prefer to be at home, so we provide as much of your care as possible as an outpatient. Offering infusion services 365 days a year at the SCCA outpatient clinic on Lake Union helps us keep your hospital stay shorter.

Phase 2: ALL consolidation therapy

About 80 percent of people with newly diagnosed ALL enter remission after induction therapy. Consolidation therapy is meant to prevent a relapse. It involves chemotherapy, steroids and targeted therapy and usually lasts a few weeks to a few months. 

If your leukemia does not respond well to induction therapy, your doctors will recommend a different treatment regimen. In this case, or if your leukemia has particular features that suggest it might be harder to treat, your doctors may also recommend a bone marrow transplant to try to prevent relapse.

Phase 3: ALL maintenance therapy

Most patients in remission go on maintenance therapy to lower the risk of a recurrence. This phase may last for a few years. It usually consists of lower doses of chemotherapy and targeted therapies. Some people in remission have a bone marrow transplant.

Phases of ALL treatment

Acute lymphoblastic leukemia treatment is generally done in three phases.

Chemotherapy

Chemotherapy drugs are usually given through an intravenous (IV) line in repeating cycles that range from two to six weeks. 

Your SCCA team will talk with you about the specific drugs we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout SCCA.

Some of the chemotherapy 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)
Chemotherapy

Chemotherapy drugs are usually given through an intravenous (IV) line in repeating cycles that range from two to six weeks. 

Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells or they prompt your immune system to attack particular cells (also called immunotherapy). 

Therapies called Abelson tyrosine kinase inhibitors (ABL TKIs) are used for PH+ ALL. They block the leukemia-causing effects of the protein made by the BCR-ABL gene — an abnormal gene in the Philadelphia chromosome.

Some of the targeted drugs used for PH+ ALL include:

  • Dasatinib (Sprycel)
  • Imatinib (Gleevec)
  • Nilotinib (Tasigna)
  • Ponatinib (Iclusig)

They are typically taken daily as pills. 

For some people with ALL, another targeted therapy called inotuzumab ozogamicin (Besponsa) may be an option. It uses an antibody to deliver an anti-cancer drug to your cancerous B cells. 

Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells or they prompt your immune system to attack particular cells (also called immunotherapy). 

Immunotherapy

For ALL that has come back or didn’t respond to other treatments (relapsed or refractory ALL), your doctor may recommend a form of treatment that harnesses your immune system, such as one of these:

  • Blinatumomab (Blyncyto®) — a type of antibody therapy that helps your body’s T cells recognize and destroy cancerous B cells
  • Tisagenlecleucel (Kymriah®) — CAR T-cell therapy 

SCCA is one of the first cancer centers in the nation to offer, tisagenlecleucel, an FDA-approved cellular immunotherapy. This CAR T-cell therapy is only available at certified treatment centers. 

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Immunotherapy

For ALL that has come back or didn’t respond to other treatments (relapsed or refractory ALL), your doctor may recommend a form of treatment that harnesses your immune system.

Bone marrow transplant

For ALL, most people having a transplant get stem cells from a donor (allogeneic transplant). The transplant works in two ways.

  1. After you receive strong chemotherapy to eliminate the ALL, the donor’s healthy stem cells restart your body’s ability to form blood cells.
  2. White blood cells from the donor may recognize as foreign and attack any leukemia cells that remain in your body. 

More people are eligible for allogeneic transplants than ever before, due to advances available at SCCA, such as:

  • Non-myeloablative (reduced-intensity) transplants, which use lower-dose chemotherapy
  • Transplants using stem cells from donated umbilical cord blood or haploidentical (half-matched) donors

Less often, doctors transplant the patient’s own stem cells, which were removed earlier and purged of leukemic cells (autologous transplant). 

Learn More About Bone Marrow Transplant

Bone marrow transplant

For ALL, most people having a transplant get stem cells from a donor (allogeneic transplant). The transplant works in two ways.