The treatment for acute lymphocytic leukemia (ALL) typically involves several phases and can include a variety of treatment modalities including chemotherapy, targeted therapies, stem cell transplant, immunotherapies and clinical trials. The treatment your ALL specialist will recommend depends on your age, ALL subtype, and if you have any other medical conditions. Explore the 8 different categories below to learn more about treatment options for ALL.

1. Induction Therapy

The goal of this initial phase of treatment is to kill the leukemia cells in the blood and bone marrow to induce remission. Typically patients are in the hospital for 4-6 weeks.

Induction therapy usually involves a combination of chemotherapy drugs such as:

• Vincristine (Oncovin)
• Anthracyclines like daunorubicin (Cerubidine) or doxorubicin (Adriamycin)
• Corticosteroids like prednisone or dexamethasone
• Pegaspargase (PEG-L asparaginase, Oncaspar) may or may not be used along with cyclophosphamide (Cytoxan)
• Intrathecal chemotherapy, where drugs are injected directly into the cerebrospinal fluid, is also used to prevent the spread of leukemia cells to the brain and spinal cord. This is called central nervous system (CNS) prophylaxis, and it is given throughout the entire course of ALL treatment. The drugs that may be used include methotrexate, cytarabine and corticosteroids.

2. Consolidation Therapy

This second phase of chemotherapy is aimed at killing any remaining leukemia cells that may not be actively dividing but could begin to regrow and cause a relapse.

Consolidation therapy usually involves chemotherapy drugs that are given in higher doses than those given during the induction phase. A combination of the following drugs may be used:

• High-dose methotrexate
• Cytarabine
• Vincristine (Oncovin)
• 6-mercaptopurine (6-MP)
• Cyclophosphamide (Cytoxan)
• Pegaspargase (PEG-L asparaginase, Oncaspar)
• Corticosteroids like prednisone or dexamethasone

3. Maintenance Therapy

This third phase of treatment involves lower doses of chemotherapy given over a longer period of time to keep the ALL from coming back. Most maintenance drugs are given orally and in an outpatient setting. 

Maintenance therapy usually involves the following drugs:

• 6-mercaptopurine
• Methotrexate
• Vincristine
• Corticosteroids

4. Stem Cell Transplant

Stem cell transplant may be a treatment option for some patients with ALL. It might be suggested if a patient's ALL has high-risk features or if the patient has relapsed. The type of transplant used for ALL is called an allogeneic stem cell transplant, meaning a patient receives stem cells from a matched donor related or unrelated donor. The process involves high-dose chemotherapy followed by an infusion of donor blood-forming stem cells.

5. Targeted Therapy

Some ALL patients have specific changes in their leukemia cells that can be targeted directly by newer drugs. These drugs are often able to stop the ALL from growing and spreading. The targeted therapy option most often used in ALL is for patients who have the Philadelphia chromosome. This class of drugs is called tyrosine kinase inhibitors (TKIs). They work by blocking a protein called tyrosine kinase, which tells the ALL cells to grow and multiply. Without the signal, the ALL cells will die and the healthy cells will be spared. TKIs are added to chemotherapy. If one TKI does not work, another one might be tried.

Tyrosine kinase inhibitors for ALL include:

• Imatinib (Gleevec)
  Dasatinib (Sprycel)
  Nilotinib (Tasigna)
  Ponatinib (Iclusig)
  Bosutinib (Bosulif)

6. Immunotherapy

Some immunotherapy drugs might also be considered forms of targeted therapy. This is a newer class of treatment options that help the immune system find and attack cancer cells. Immunotherapy drugs used for ALL:

• Blinatumomab (Blincyto): A type of monoclonal antibody that attaches to the CD19 protein on B cells including some leukemia cells while also attaching to CD3, a protein on immune cells called T cells. By binding to both of these proteins, this drug brings the cancer cells and immune cells together, which is thought to cause the immune system to attack the cancer cells. This drug is used to treat some types of B-cell ALL, typically after chemotherapy has been tried.
• Inotuzumab ozogamicin (Besponsa): An anti-CD22 antibody linked to a chemotherapy drug. The antibody brings the chemotherapy drug to the ALL cells where it enters the cells and kills them. This drug is used to treat some types of B-cell ALL, typically after chemotherapy has been tried.
• Brexucabtagene autoleucel (Tecartus): A CAR T-cell therapy that is approved to treat adults with B-cell ALL that has come back or is no longer responding to other treatments
• Tisagenlecleucel (Kymriah): A CAR T-cell therapy that is approved for use in children and young adults up to age 25 to treat B-cell ALL that has come back or is no longer responding to treatment.

7. Radiation Therapy

Radiation therapy is not commonly used as a primary treatment for ALL. However, it may be used if the leukemia cells have spread to the brain and spinal cord, or other parts of the body. It can also be used to shrink a tumor that is causing problems or to reduce bone pain that is being triggered by ALL.

8. Clinical Trials

Clinical trials are not just a last resort for treating ALL. They can actually provide access to cutting-edge treatments that are not yet approved but show promise over years of testing. The choice of a clinical trial depends on a variety of factors including the patient's age, overall health, the subtype of ALL, and genetic changes in the leukemia cells. It's important to discuss all treatment options, including goals and possible side effects, with your healthcare team to help make the best decision. 

To learn more about your ALL clinical trial options, visit HealthTree's ALL Clinical Trial Finder. Utilize the advanced filter option to locate trials that you are eligible to participate in. You can create a HealthTree account to favorite your top trial options so you can discuss them with your ALL specialist.

Want to Learn More About Acute Lymphocytic Leukemia?

Keep reading HealthTree for ALL's 101 pages!

What is Acute Lymphocytic Leukemia?
How is Acute Lymphocytic Leukemia Diagnosed?
What are the Signs and Symptoms of Acute Lymphocytic Leukemia?
How is Acute Lymphocytic Leukemia Staged and Classified?
How Long Will I Live with Acute Lymphocytic Leukemia?