Leukemia--Acute Lymphocytic

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Treating Leukemia - Acute Lymphocytic (ALL) in Adults TOPICS

What if the leukemia doesn’t respond or comes back after treatment?

If the leukemia is refractory – that is, if it doesn’t go away with the first treatment (which happens in about 10% to 20% of patients) – then newer or more intensive doses of drugs may be tried, although they are less likely to work. Blinatumomab (Blincyto) may be an option for patients with B-cell ALL. A stem cell transplant may be tried if the leukemia can be put into at least partial remission. Clinical trials of new treatment approaches may also be considered.

If leukemia goes into remission with the initial treatment but then comes back (recurs), it will most often do so in the bone marrow and blood. Occasionally, the brain or spinal fluid will be the first place it recurs.

In these cases, it is sometimes possible to put the leukemia into remission again with more chemotherapy (chemo), although this remission is not likely to last. The approach to treatment may depend on how soon the leukemia returns after the first treatment. If the relapse occurs after a long interval, the same or similar treatment may be used to try for a second remission. If the time interval is shorter, more aggressive chemo with other drugs may be needed. Blinatumomab (Blincyto) may be an option for patients with B-cell ALL.

ALL patients with the Philadelphia chromosome who were taking a targeted drug like imatinib (Gleevec) are often switched to another targeted drug.

For patients with T cell leukemia, the chemo drug nelarabine (Arranon®) may be helpful.

If a second remission can be achieved, most doctors will advise some type of stem cell transplant if possible.

If the leukemia doesn’t go away or keeps coming back, eventually chemo treatment will not be very helpful. If a stem cell transplant is not an option, a patient may want to consider taking part in a clinical trial of newer treatments.

Palliative treatment

At some point, it may become clear that further treatment, even in clinical trials, is extremely unlikely to cure the leukemia. At that time, the focus of treatment may shift to controlling symptoms caused by the leukemia, rather than attempting to cure the leukemia. This may be called palliative treatment or supportive care. For example, the doctor may advise less intensive chemo to try to slow the leukemia growth instead of trying to cure it.

As the leukemia grows in the bone marrow it may cause pain. It is important that you be as comfortable as possible. Treatments that may be helpful include radiation and appropriate pain-relieving medicines. If medicines such as aspirin and ibuprofen don’t help with the pain, stronger opioid medicines such as morphine are likely to be helpful.

Other common symptoms from leukemia are low blood counts and fatigue. Medicines or blood transfusions may be needed to help correct these problems. Nausea and loss of appetite can be treated with medicines and high-calorie food supplements. Infections that occur may be treated with antibiotics.

For more information on palliative treatment, please see the section “If treatment for acute lymphocytic leukemia stops working.”

Last Medical Review: 12/02/2014
Last Revised: 01/12/2015