Surgery for Acute Lymphocytic Leukemia (ALL)

(Note: This information is about treating acute lymphocytic leukemia (ALL) in adults. To learn about ALL in children, see Leukemia in Children.)

Surgery has a very limited role in the treatment of acute lymphocytic leukemia (ALL). Because leukemia cells are spread widely throughout the bone marrow and blood, it isn't possible to cure this type of cancer with surgery. Aside from a possible lymph node biopsy, surgery rarely has a role even in the diagnosis of ALL, as this is typically done with a bone marrow aspiration and biopsy.

The main role for surgery in ALL is to insert catheters (tubes) into the body to make it easier to give chemotherapy (chemo), which is the main treatment for ALL.

Placement of a central venous catheter

Often before chemo is about to start, surgery is often needed to insert a small plastic tube, called a central venous catheter (CVC), central line, or venous access device (VAD), into a large vein (usually in the chest). The end of the tube stays just under the skin or sticks out in the chest area or upper arm.

The CVC is left in place during treatment (often for many months) to give intravenous (IV) drugs such as chemo and to take blood samples. This lowers the number of needle sticks needed during treatment. It is very important to learn how to care for the device to keep it from getting infected.

Placement of an Ommaya reservoir

Giving chemo directly into the fluid that surrounds the brain and spinal cord (cerebrospinal fluid or CSF) is often a part of the treatment of ALL. In this treatment, called intrathecal chemo, the medicines can be given through a lumbar puncture (spinal tap) or through an Ommaya reservoir.

An Ommaya reservoir is a dome-like device attached to a catheter, which is put in place during a surgical procedure. The dome part sits under the skin of the scalp, with the catheter going through a small hole in the skull and into one of the spaces (ventricles) in the brain.

Intrathecal chemo can be given by placing a needle through the skin and into the dome . The chemo goes through the catheter and into the CSF in the ventricle, and then circulates through the area around the brain and spinal cord.

An Ommaya reservoir allows a person to get intrathecal chemo without having to get repeated spinal taps. CSF can also be withdrawn from the Ommaya reservoir to check for leukemia cells and signs of infection.

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Appelbaum FR. Chapter 98: Acute Leukemias in Adults. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa. Elsevier: 2014.

Jain N, Gurbuxani S, Rhee C, Stock W. Chapter 65: Acute Lymphoblastic Leukemia in Adults. In: Hoffman R, Benz EJ, Silberstein LE, Heslop H, Weitz J, Anastasi J, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, Pa: Elsevier; 2013.

National Comprehensive Cancer Network. NCCN Practice Guidelines in Oncology: Acute Lymphoblastic Leukemia. V.1.2018. Accessed at www.nccn.org/professionals/physician_gls/pdf/all.pdf on July 26, 2018.

Last Medical Review: October 17, 2018 Last Revised: October 17, 2018

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