Leukemia--Acute Lymphocytic Overview

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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 doesn't go away with the first treatment then newer drugs or stronger doses may be tried, although they are less likely to work. 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 an option.

If the leukemia goes into remission with the first treatment but then comes back (recurs), it will most often do so in the bone marrow and blood. Once in a while, the brain or spinal fluid will be the first place it returns. In these cases, more chemotherapy (chemo) might put the disease back into remission, although this is not likely to last. If a second remission can be achieved, most doctors will suggest some type of stem cell transplant if possible.

If the leukemia keeps coming back or doesn't go away, over time chemo will not be very helpful. If a stem cell transplant is not an option, a clinical trial might be an option.

Some people want to keep on having treatment to fight the leukemia as long as they can. It is a good idea, though, to think about the odds of more treatment doing any good before making the decision to continue. Some people are tempted to try more chemo, for example, even when their doctors say that the odds of benefit are less than 1 in 100. In these cases, it is important to think about and understand your reasons for choosing this plan.

Palliative treatment

If a clinical trial is not an option, or if it becomes clear that further treatment, even in clinical trials, is very unlikely to cure the leukemia, then it may be time to focus on relieving symptoms. This is known as palliative treatment. The doctor may suggest milder chemo to try to slow the growth of the leukemia in order to reduce symptoms.

If there is pain, it's important to treat it. Pain-killing medicines or radiation may be helpful. Sometimes medicines or blood transfusions are needed to correct low blood counts and tiredness. Nausea and loss of appetite may be helped by medicines and high-calorie food supplements. Antibiotics may be needed to treat infection.

To learn more about palliative treatment, please see the section, "If treatment for acute lymphocytic leukemia stops working."

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