Acute Lymphocytic Leukemia (ALL): Treatment Choices 

There are various treatment choices for acute lymphocytic leukemia (ALL). Which one may work best for you? It depends on a number of factors, such as:

• Your age and overall health

• Your subtype of ALL

• Results of your lab tests

• If the leukemia cells have gene or chromosome changes

• If the leukemia is affecting the brain and spinal cord, spleen, or liver

• Your personal needs and preferences

• How well the leukemia responds to the first treatment

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision for you.

Types of treatment for ALL 

Chemotherapy

This is the main way to treat ALL. The treatment uses medicines to kill cancer cells. The medicines are put into your blood. The goal is to kill the cancer cells and put the cancer into remission. Remission means there are no signs of cancer in the body. The medicines may also be injected into your cerebrospinal fluid (CSF) to prevent cancer growth or to reach cancer cells around the brain and nervous system. This is called intrathecal chemotherapy. It’s also called central nervous system prophylaxis.

Radiation therapy

This type of therapy uses high-energy X-rays to kill cancer cells. It's not part of the main treatment for ALL, but it may be used to kill or prevent the spread of cancer in your nervous system. It may be used right before a stem cell transplant. In rare cases, it may be done to shrink a tumor.

Stem cell transplant with high-dose chemotherapy

If the normal doses of chemotherapy don't work, your doctor may need to give you very high doses of chemotherapy. These high doses can damage the stem cells in your bone marrow. Blood stem cells are the "starter" cells for new blood cells. In some cases before chemotherapy, the doctor removes some stem cells from a volunteer donor and freezes them. They are then given to you after treatment to restore your body's ability to make blood cells. This is called a stem cell transplant.

Targeted therapy

These are medicines that target abnormal proteins, such as those caused by the Philadelphia chromosome. The medicines include imatinib, dasatinib, and nilotinib. They may be helpful in treating ALL that has this mutation. These medicines are taken daily as pills.

Clinical trials for new treatments

Researchers are always finding new ways to treat ALL. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare providers

At first, thinking about treatment options may seem overwhelming. Talk with your doctors, nurses, and loved ones. Make a list of questions. Consider the benefits and possible side effects of each option. Discuss your concerns with your healthcare providers before making a decision.