Acute Lymphocytic Leukemia - Treatment

Treatment

The aim of initial treatment is to get rid of the leukemia cells in the body (achieve complete remission) and have 5% of lower levels of blasts in the bone marrow.

Treatment Phases

There are typically four treatment stages for the average-risk patient with ALL:

• Induction therapy and usually central nervous system prophylaxis (preventive treatment) to achieve a first remission
• Consolidation and maintenance to prevent relapse after remission

Specific Treatments Used in ALL

The following are specific treatments used for ALL:

• Chemotherapy is the primary treatment for each stage.
• Radiation to the brain and spinal cord is also administered in some cases.
• A bone marrow transplant is often recommended for relapsed ALL or in cases that cannot be induced into remission (refractory disease). It is also sometimes considered after remission is achieved for certain high-risk ALL types. The timing of bone marrow transplantation can be controversial, particularly after a first remission, although it has produced excellent long-term survival rates in appropriate patients.
• New drugs known as biological therapies are also being used.

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Supportive Treatment

Drugs Used to Prevent Infections During Treatment. Half of all patients with ALL develop fever in the early stages, especially if patients also have low levels of the white blood cells called neutrophils (a condition called neutropenia).

Neutropenia is common in ALL and is a significant risk factor for serious infection. Of increasing concern are fungal infections, which are becoming more common in these patients, particularly after transplant procedures.

• Antibiotics and Antifungal Medications. The use and timing of antibiotics and antifungal medications depend on the particular organisms and severity of the infection. In some cases of neutropenia, patients may need preventive antibiotics.
• Granulocyte Colony-Stimulating Factor. Granulocyte colony-stimulating factor (lenograstim, filgrastim) is often given to patients who receive chemotherapy in order to stimulate the growth of infection-fighting white blood cells. This helps prevent neutropenia.

Intravenous Fluids. Patients may also need to receive intravenous fluids and be treated for fluid imbalances, which can cause abnormal levels of sodium, potassium, calcium, and uric acid. Such treatments might include sodium bicarbonate, allopurinol, and aluminum hydroxide or calcium carbonate.

Transfusions. Red blood cell or platelet transfusions may be needed. (Patients who may need allogeneic transplantations should not receive transfusions from potential donors.)

Review Date: 01/16/2007
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital