Acute lymphoblastic leukemia treatment

How is ALL treated?

Because it progresses quickly, treatment needs to begin soon after ALL is diagnosed. The type of treatment used will depend on a number of factors including the sub-type of ALL, the genetic make-up of the leukaemic cells, your age and your general health.

Chemotherapy

Chemotherapy is the main form of treatment for ALL. A combination of drugs, including steroids, is usually given in several cycles with a rest period of a few weeks in between. Initially, the aim of treatment is to destroy leukaemic cells and induce a remission. This means that there is no evidence of leukaemic cells in the blood and bone marrow and that normal blood cell production and blood counts are restored. In some cases, where there is a high risk that the leukaemia will relapse, patients may be offered even more intensive therapy followed by a stem cell transplant.

Chemotherapy is given in many different ways to treat ALL. This includes intravenously (into a vein), intramuscularly (into a muscle) and in tablet form. To prevent and treat disease in the brain and spinal cord (CNS) chemotherapy is injected intrathecally, directly into the fluid that surrounds these structures. Sometimes, this area is also treated using radiotherapy. In males, radiotherapy may be given to the testes to treat relapsed disease in this area.

Treatment for ALL can be divided into three phases:

• induction therapy
• post-remission (consolidation) therapy
• maintenance therapy.

Induction therapy

Soon after you are diagnosed your doctor will need to begin an intensive course of treatment to bring about, or induce, a remission. You will need to be admitted to hospital for this first phase of treatment. Sometimes the disease does not respond to treatment as expected and you may be said to have resistant or refractory disease. In these cases the doctor may recommend a more intensive form of therapy to treat your disease more effectively.

Post-remission (consolidation) therapy

Soon after induction therapy finishes and remission is achieved, more treatment is required to help destroy any leftover disease in your body. This is important because it helps to prevent the disease from reappearing (relapsing), or spreading to the central nervous system (brain and spinal cord) in the future. The type of consolidation therapy chosen for you will depend on your estimated risk of relapse in the future, in other words the ‘risk group’ to which you belong Consolidation therapy usually involves ‘blocks’ of treatment over several months. Some people may be offered more intensive treatment followed by a stem cell transplant, to more effectively treat their disease.

Maintenance therapy

Maintenance therapy is designed to help keep your disease in remission and prevent it from reappearing (relapsing) in the future. Common maintenance protocols involve chemotherapy tablets — some taken daily and others weekly — and possibly blocks of injections of chemotherapy with courses of cortico-steroids. This phase of treatment usually lasts for several months during which time you will be treated as an outpatient; however sometimes you may need to be admitted to hospital.

Your prognosis is an estimate of the likely course of your disease and whether it is likely to relapse in the future. It provides some guide regarding the chances of curing the disease or controlling the disease for a given time. Your doctor is the best person to give you an accurate prognosis regarding your leukaemia as he or she has all the necessary information to make this assessment.