blood disorders
Acute Lymphoblastic Leukemia (ALL)
Treatment of ALL
Treatment consists of Chemotherapy Other drugs, such as immunotherapy and/or targeted therapy Rarely, stem cell transplantation or radiation therapy Chemotherapy is highly effective and is administered in phases: Induction Treatment of the brain Consolidation and intensification Maintenance Inductionchemotherapy is the initial phase of treatment. The goal of induction chemotherapy is to achieve remission by destroying leukemia cells so that normal cells can once again grow in the bone marrow. People may need to stay in the hospital for days or weeks, depending on how quickly the bone marrow recovers. , given intravenously. Immunotherapy for Cancer (a treatment that uses a person's own immune system to kill cancer cells) and targeted therapy (drugs that are directed at abnormal genes or proteins in cancer cells) can be used in some patients with ALL. Treatment of the brainusually begins during induction and may continue during all phases of treatment. Because ALL is likely to spread to the brain, treatment concentrates on treating leukemia that has spread to the brain or on preventing the spread of leukemia cells to the brain. For treatment of leukemia cells in the layers of tissue covering the brain and spinal cord (the meninges),methotrexate,cytarabine, corticosteroids, or a combination are usually injected directly into the cerebrospinal fluid, or high doses of these drugs may be given by vein (intravenously). This chemotherapy may be given in combination with radiation therapy to the brain. continues to treat bone marrow disease. Additional chemotherapy drugs, or the same drugs as were used during the induction phase, may be used a few times over a period of several weeks. For some people who are at high risk of relapse because of particular chromosomal changes found in their leukemia cells, Stem Cell Transplantation is done once remission occurs. Furthermaintenance chemotherapy,which usually consists of fewer drugs, sometimes at lower doses, usually continues for 2 to 3 years. Older people with ALL may not be able to tolerate the intensive regimen used for younger people. In these people, gentler induction regimens alone (without subsequent consolidation, intensification, or maintenance) is an option. Sometimes, immunotherapy or a gentler form of stem cell transplantation may be an option in some older people. During all the above phases, blood and platelet transfusions may be necessary to treat anemia and to prevent bleeding, and antimicrobials may be needed to treat infections. Intravenous fluids and therapy with eitherallopurinolorrasburicasemay also be used to help rid the body of harmful substances, such as uric acid, that are released when leukemia cells are destroyed. Leukemia cells may begin to appear again (a condition termed relapse), often in the blood, bone marrow, brain, or testes. Early reappearance in the bone marrow is particularly serious. Chemotherapy is given again, and although many people respond to this repeat treatment, the disease has a strong tendency to come back again, especially in infants and in adults. When leukemia cells reappear in the brain, chemotherapy drugs are injected into the cerebrospinal fluid 1 or 2 times a week. When leukemia cells reappear in the testes, radiation therapy to the testes is given along with chemotherapy. For people who have relapsed, high doses of chemotherapy drugs along with allogeneic Stem Cell Transplantation ("allogeneic" means the stem cells are from another person) offers the best chance of cure. But transplantation can be done only if stem cells can be obtained from a person who has a compatible tissue type ( Therapies using monoclonal antibodies (proteins that attach specifically to the leukemia cells, tagging them for destruction) are also used in some people with relapsed ALL. In some people with relapsed ALL, Combination Cancer Therapy (CAR-T) can be used. This therapy involves modifying a type of lymphocyte (T lymphocytes, also called T cells) from the person who has leukemia so that the new T cells will recognize and attack leukemia cells. After relapse, additional treatment for people who are unable to undergo stem cell transplantation is often poorly tolerated and ineffective, frequently causing people to feel much sicker. However, remissions can occur. Introduction to Death and Dying should be considered for people who do not respond to treatment. 