How long is Treatment for Acute Lymphoblastic Leukemia?

by Ankita Mathur Medical Consultant

Overview

The acute lymphoblastic leukemia (ALL) is a type of blood cancer also known as acute lymphoid leukemia and acute lymphocytic leukemia. ALL is the most common type of leukemia in children. The advances in the treatment of ALL have resulted in improved remission rates. Also each years, the number of patients gone into remission or have been cured are increasing. Around 6,070 people in the United States were expected to be diagnosed with ALL in 2013. As of the year 2013, Nearly 66,030 people in the US are living with or are in remission from ALL.

The treatment for acute lymphoblastic leukemia (ALL) varies according to the patient’s age, general condition at diagnosis and the results of the cytogenetic testing. The standard therapy for ALL has changed little in the past 15 years. The current strategy has been quite effective to cure adults and our goal is to cure.

The treatment for acute lymphoblastic leukemia (ALL) includes four phases:

First phase is induction chemotherapy
Second phase is consolidation chemotherapy
Third phase is maintenance chemotherapy
Fourth phase is central nervous system (CNS) prophylaxis

The first two phases use the intensive chemotherapy medications for killing the leukemia cells which grow quickly. The complete therapy for ALL will typically continue for two to three years. The complete remission a cure is achieved in about 90% of patients with 25 to 40% enjoying long-term survival. Around 5% of patients die with treatment-related complications during the initial therapy and another 5% never achieved an initial remission.

The total treatment usually takes around two years with maintenance phase taking up the most of the time. Depending on the subtype of ALL and other prognosis factors, treatment may be more or less intense.

Induction Chemotherapy

The most common drugs used for induction treatment of ALL are vincristine, daunorubicin, asparanginase, prednisone and sometimes cyclophosphamide. The intensive supportive care escorts with chemotherapy cost which include the transfusion of red blood cells and platelets.

Antibiotics are required for both preventatively and as treatments for fungal and bacterial infections. Also the agent G-CSF or Neupogen is useful to rapidly re-establish a normal white blood count. Though the likelihood of mouth sores and disruption of the intestinal tract is rare but complete yet temporary hair loss might occur.

A repeat bone marrow biopsy is done to determine whether the patient’s enter complete remission with no evidence on the persistent leukemia once the blood count comes to normal.

Consolidation (Intensification) Chemotherapy

Typically it includes multiple cycles of intensive chemotherapy given over a period of six to nine months. Frequent hospitalizations are needed along with intensive supportive care including the red blood cell and platelet transfusion. The stem cell transplantation is not typically done for treating ALL unless the abnormal cytogenetics is present.

During this phase, the chemotherapy agents used are the same agents used during induction as well as methotrexate, Ara-C and 6-mercaptopurine.

Maintenance Chemotherapy

Even after completing the intensive chemotherapy, the patients will need to take the oral chemotherapy pills for an additional 18 to 24 months. Usually, the oral chemotherapy pills are well-tolerated with optimum side effects. Patient will need to get their blood tests done once a month while taking them. Most patients with ALL can resume their work during the maintenance therapy.

Central Nervous System (CNS) Prophylaxis

Frequently ALL can recur in the spinal fluid which bathes the spinal column and the brain. Chemotherapy is injected directly into the fluid by inserting a needle between the vertebrae of the lower back called a lumbar puncture or a spinal tab and infuse it directly, called as Intrathecal chemotherapy. This will prevent the relapse.

Routinely patients will be given six or more injections of Intrathecal chemotherapy for preventing the recurrence of ALL. If the leukemia cells are detected in the spinal fluid then more injections are necessary.

Most people complete this therapy within two to four months of starting their treatment.

Conclusion

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