Different treatment options are available for treating acute lymphoblastic leukemia (ALL). Some conventional standard treatments are already established in the medical field for treating ALL and some of the novel treatment options are being tested in clinical research.
- Oncology specialists and medical teams decide the treatment factors by considering the individual patient’s condition and their preference. Usually adult ALL patients have two treatment phases – Remission induction therapy and Post-remission therapy. Children with ALL have three treatment phases – Remission induction, Consolidation/intensification, and Maintenance.
- Four types of standard ALL treatment are chemotherapy, radiation therapy, chemotherapy with stem cell transplant, and targeted therapy
- The primary aim to treat ALL is to kill leukemia cells that have spread or may spread to the brain, spinal cord, or testicles.
- Novel treatment approach i.e. immunotherapy is being tested through clinical trials
- The available treatments of ALL usually have side effects.
- Some ALL patients may have an interest to take part in a clinical trial. These patients may eligible for participating in a clinical trial before, during, or after starting their cancer treatment that depends upon the protocol of the trial.
- Follow-up tests may be required in every treatment aspect.
Standard four ALL treatment options are as follows:
Chemotherapy
Chemotherapy use in cancer treatment can either killing the cancer cells or stop their proliferation by ceasing cell division. Intrathecal chemotherapy is preferable when the drug is directly inserted into the cerebrospinal fluid for adult ALL treatment in case of leukemia spreads or may spread to the brain and spinal cord. Otherwise, systemic chemotherapy is a conventional treatment. In this process, the drug is directly injected into the bloodstream through an intravenous route.
Radiation therapy
High energy X-rays or other radiations are used in radiation therapy to kill or stop the growth of cancer cells. External radiation therapy can use to treat adult ALL that has spread or may spread to the central nervous system. This can also use to provide symptomatic relief in palliative care to improve their quality of life. Total-body radiation is a type of radiation therapy preferably use before stem cell transplant for preparing the body.
Chemotherapy with stem cell transplant
Chemotherapy kills both cancerous and healthy cells. Blood-forming cells are often destroyed due to chemotherapy. Stem cell transplant can replace the blood-forming cells. Stem cells are collected from the patient body or donor and freezing them for storage purposes. The frozen stem cells are thawed and given back to the patient after completion of chemotherapy or even after total-body radiation therapy by an infusion method. These re-infused stem cells grow and restore in the patient body to complement the new blood cell growth.
Targeted therapy
The given treatment in the targeted therapy invades cancer cells and less harmful for normal cells as occurs in chemotherapy or radiation therapy.
Monoclonal antibody therapy: laboratory-made antibodies that formed from a single type of immune system cell. The monoclonal antibodies identify and attach to the cancer cell or substance that helps in cancer growth to block the growth and spreading of cancer.
Blinatumomab and inotuzumab ozogamicin are available monoclonal antibody therapy to treat adult ALL. This treatment usually uses with stem cell transplants.
Tyrosine kinase inhibitor therapy: This treatment obstructs the enzyme, tyrosine kinase. This enzyme takes part in the conversion of stem cells into white blood cells and increases their number more than the bodily requirement. Imatinib mesylate, dasatinib, and nilotinib are some examples of tyrosine kinase inhibitors that are used in adult ALL treatment.
Drugs Approved for Acute Lymphoblastic Leukemia (ALL)
- Arranon (Nelarabine)
- Asparaginase Erwinia chrysanthemi
- Asparlas (Calaspargase Pegol-mknl)
- Besponsa (Inotuzumab Ozogamicin)
- Blinatumomab
- Blincyto (Blinatumomab)
- Calaspargase Pegol-mknl
- Cerubidine (Daunorubicin Hydrochloride)
- Clofarabine
- Clolar (Clofarabine)
- Cyclophosphamide
- Cytarabine
- Dasatinib
- Daunorubicin Hydrochloride
- Dexamethasone
- Doxorubicin Hydrochloride
- Erwinaze (Asparaginase Erwinia Chrysanthemi)
- Gleevec (Imatinib Mesylate)
- Iclusig (Ponatinib Hydrochloride)
- Inotuzumab Ozogamicin
- Imatinib Mesylate
- Kymriah (Tisagenlecleucel)
- Marqibo (Vincristine Sulfate Liposome)
- Mercaptopurine
- Methotrexate Sodium
- Nelarabine
- Oncaspar (Pegaspargase)
- Pegaspargase
- Ponatinib Hydrochloride
- Prednisone
- Purinethol (Mercaptopurine)
- Purixan (Mercaptopurine)
- Rubidomycin (Daunorubicin Hydrochloride)
- Sprycel (Dasatinib)
- Tisagenlecleucel
- Trexall (Methotrexate Sodium)
- Vincristine Sulfate
- Vincristine Sulfate Liposome
Drug Combinations Used in Acute Lymphoblastic Leukemia (ALL)
Hyper-CVAD is an abbreviation used in combination with chemotherapy used for treating ALL and non-Hodgkin lymphoma. Cyclophosphamide, doxorubicin hydrochloride, dexamethasone, and vincristine sulfate are the drugs used in hyper-CVAD. Cytarabine and methotrexate are the other two drugs also included in hyper-CVAD. The drug administration process in hyper-CVAD is termed hypofractionated therapy. In this therapy, the total given dose of the drugs is distributed into small doses and administers more than once a day.
Immunotherapy
The aim to prescribe immunotherapy to cancer patients is to activate the immune system against cancer. The substances used in immunotherapy may produce in the body or laboratory to directly boost natural defense mechanisms or restore the immune functioning to fight against cancer. Immunotherapy is also termed biological therapy or biotherapy.
CAR T-cell therapy: This is an example of immunotherapy that can change the patient’s T cells (a type of immune system cell) to attack certain proteins present on the surface of cancer cells. In this treatment, T cells are collected from the patient and special receptors are added to their surface in the medical laboratory. The altered T cells are known as chimeric antigen receptor (CAR) T cells. The CAR T cells are administered to the patient by the infusion method. The CAR T cells multiply in the patient’s blood and attack cancer cells. CAR T-cell therapy is especially given to adult patients who have recurrence ALL.
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