Leukemia--Acute Lymphocytic Overview

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Treating Leukemia - Acute Lymphocytic (ALL) in Adults TOPICS

Chemotherapy for acute lymphocytic leukemia

Chemotherapy (chemo) is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. But most chemo drugs don't reach the area around the brain and spinal cord. That's why they may need to be put right into the cerebrospinal fluid to kill cancer cells in that area.

If you have acute lymphocytic leukemia (ALL) and are being treated with chemo, you will be given several drugs over a long period of time (often about 2 years). Treatment is separated into phases (see below).

Side effects of chemo

Chemo drugs kill fast-growing cells such as cancer cells, but in the process they also damage other normal cells that grow fast.

The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Common side effects might include:

  • Hair loss
  • Mouth sores
  • Higher risk of infection (from low white blood cells)
  • Easy bruising or bleeding (from low blood platelets)
  • Tiredness (from low red blood cells)
  • Loss of appetite
  • Nausea
  • Vomiting
  • Diarrhea

Most side effects usually go away after treatment ends. Be sure to talk to your doctor if you are having trouble with side effects because there are often ways to manage them during treatment. For example, there are drugs that can be taken along with the chemo to help prevent or reduce nausea and vomiting. Drugs called growth factors are sometimes given to keep your blood counts higher and reduce the chance of infection.

If your white blood cell counts are very low during treatment, you can help reduce your risk of infection by avoiding germs. During this time, your doctor or nurse may tell you to:

  • Wash your hands often.
  • Avoid fresh, uncooked fruits and vegetables and other foods that might carry germs.
  • Avoid fresh flowers and plants because they may carry mold.
  • Make sure other people wash their hands when they come in contact with you.
  • Avoid large crowds and people who are sick (wearing a surgical mask can help protect you).

During and after treatment, you might also get antibiotics or other drugs as added protection. If your platelet counts are low, you might get platelet transfusions to keep you from bleeding. Low red blood cell counts, causing shortness of breath and tiredness, can be treated with drugs or with blood transfusions.

Organs that could be damaged by chemo include the kidneys, liver, testicles, ovaries, brain, heart, and lungs. By watching you carefully, the doctor may be able to prevent much of the damage. If serious side effects happen, the drugs may have to be reduced or stopped. Be sure to tell your doctor about any problems you have.

One of the most serious side effects of chemo for ALL is the increased risk of getting acute myelogenous leukemia (AML) later. Less often, people cured of leukemia may later get non-Hodgkin lymphoma or other cancers. Of course, the risk of getting these second cancers must be balanced against the clear need to treat a life-threatening disease such as leukemia with chemo.

Tumor lysis syndrome is a side effect caused by the rapid breakdown of large numbers of leukemia cells. This sometimes happens when treatment is started, but it is not a concern later on (when there are fewer leukemia cells). When leukemia cells die, they break open and release their contents into the bloodstream. This cell waste can affect the kidneys, heart, and nervous system. Giving extra fluids or certain drugs can help the body get rid of these substances.

Chemo treatment phases for acute lymphocytic leukemia

For acute lymphocytic leukemia (ALL), chemotherapy (chemo) treatments are given in the phases described below. The total treatment usually takes about 2 years. Treatment may be more or less intense, depending on the subtype of ALL and other factors.

Remission induction (sometimes just called induction)

The purpose of the first phase is to bring about a remission. A remission means leukemia cells are no longer found in bone marrow samples, even after the normal marrow cells return and the blood counts become normal. But this is not the same as a cure, as leukemia cells are likely to still be hiding somewhere in the body.

More than one chemo drug will be used and high doses will be given. This phase usually lasts for a month or so. Treatment to keep the leukemia cells from spreading to the central nervous system is often started at this time. This could include high-doses of certain chemo drugs, chemo put right into the spinal fluid, or radiation to the brain and spinal cord. If the ALL cells have a certain gene change, a targeted therapy drug is a part of treatment.

Treatment in this phase can often have serious side effects, including life-threatening infections. For this reason, the doctor will watch you closely and prescribe drugs like antibiotics if needed. You may spend some or much of this time in the hospital.

Consolidation

If the patient goes into remission, the next phase is often a treatment over the next few months with chemo (sometimes with targeted therapy) using many of the same drugs that were used before. This may include chemo into the spinal fluid. This treatment phase is often easier to take than induction.

Doctors may suggest a stem cell transplant (SCT) for patients who are at a high risk of the leukemia coming back. Patients looking at a SCT might think about having it done as part of a clinical trial at a center that has done a lot of SCT procedures. Please see the section, "Stem cell transplant for acute lymphocytic leukemia" for more details

Maintenance

The last phase of treatment, called maintenance, is meant to help keep the leukemia from coming back. It uses lower doses of chemo drugs given over about 2 years. For people whose ALL cells have a certain gene change, maintenance often includes a targeted therapy drug. Chemo may also continue to be given into the spinal fluid.


Last Medical Review: 06/25/2013
Last Revised: 02/07/2014