Hematologic Malignancies Program

Adult Acute Lymphocytic Leukemia

Treatment Options

The primary treatment for patients with adult acute lymphocytic leukemia is chemotherapy. Radiation therapy may be used in certain cases. Stem cell transplantation is being studied in clinical trials.

If leukemia cells have spread to the brain, patients may receive radiation therapy or chemotherapy to the brain. Patients may also receive central nervous system (CNS) prophylaxis, another type of therapy, to prevent leukemia cells from growing in the brain during induction therapy and remission.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Some anticancer drugs are injected into a vein (IV) or muscle; others are given by mouth or injected into the skin. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. Chemotherapy may sometimes be put into the fluid that surrounds the brain by inserting a needle into the brain or back (intrathecal chemotherapy). It is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on.

Chemotherapy drugs generally target rapidly dividing cancer cells. However, other cells that also divide rapidly include blood cells, cells that line the digestive tract, and cells in hair follicles. Unfortunately, these healthy cells may also be impacted by the chemotherapy drugs, resulting in side effects such as infections, tiredness, temporary hair loss, mouth sores, and other symptoms.

Not all chemotherapy patients develop all of these symptoms, and they usually go away during the recovery period or after treatment stops. Medicines and other treatments are available to control or minimize many of these symptoms.

Radiation Therapy

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for adult acute lymphocytic leukemia usually comes from a machine outside the body (external radiation therapy). The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

Stem Cell Transplantation

Stem cell transplantation is a treatment in which a patient's diseased bone marrow is replaced with healthy stem cells to repopulate the marrow.

Allogeneic Transplant: A transplant using marrow from a relative or person not related to the patient is called an allogeneic transplant. Allogeneic transplants may be done using either a standard high-dose therapy or a less toxic, nonablative, immunosuppressive therapy.

In the standard high-dose therapy approach, all of the bone marrow in the body is destroyed with high doses of chemotherapy with or without radiation therapy. Healthy marrow or blood stem cells are then taken from another person (a donor) whose tissue is the same or almost the same as that of the patient. The donor may be a twin (the best match), a brother or sister, or a person who is not related. The healthy stem cells from the donor are then transferred to the patient through a needle in the vein, and the new marrow replaces the original marrow that was destroyed.
In a nonmyeloablative transplant, the goal is not to destroy the patient's marrow but to allow for the donor cells to take hold or "engraft." In this type of transplant, less intensive medications are used and the marrow is not completely destroyed prior to the transplant.

Autologous Transplant: Another type of bone marrow transplant, called an autologous bone marrow transplant, is being studied in clinical trials. In this type of transplant, blood stem cells are taken from the patient after treatment with drugs to kill cancer cells. The stem cells that were taken from the patient are then frozen and stored. Next, high-dose chemotherapy is given to the patient with or without radiation therapy to destroy the remaining leukemia cells. The frozen stem cells are then thawed and given back to the patient through a needle in a vein to repopulate the marrow and make blood cells.

A greater chance for recovery occurs in hospitals that do more than five stem cell transplantations a year.

This page was last updated on: March 3, 2008.