Treatment

It's important that your doctor is experienced in treating patients with acute leukemia or has access to an acute lymphoblastic leukemia (ALL) specialist.

Types of ALL Treatment

Doctors use several types of approaches and treatment combinations for ALL:

Chemotherapy
Stem cell transplantation
Ph-positive ALL therapy
Clinical trials. Clinical trials can involve therapy with new drugs and new drug combinations or new approaches to stem cell transplantation.

Finding the Best Treatment Approach

Patients who have ALL need treatment as soon as possible after diagnosis. If time allows, however, a patient may want to seek a second opinion. A second opinion may help a patient to feel more confident about the chosen treatment plan. The approach for treating each patient is based on an individual’s subtype, risk factors and treatment goals.

The treatment your doctor recommends is based on several factors. Factors that may affect treatment include

Your ALL subtype
The stage and category of the disease
Disease that has not responded to treatment, called refractory disease
Disease that has come back after treatment, called relapsed disease
Your age
Other medical problems, such as diabetes, or heart or kidney disease

Some things that may affect the outcome of your ALL treatment are

The subtype of your ALL
The results of your lab tests
Your age and general health
Your medical history, including whether you were treated before with chemotherapy
Whether you have
- A serious infection at the time of diagnosis
- ALL in your central nervous system
- ALL that has not responded to treatment or has relapsed

As you develop a treatment plan with your doctor, be sure to discuss

The results you can expect from treatment
The possibility of participating in a clinical trial, where you'll have access to advanced medical treatment that may be more beneficial to you than standard treatment
Potential side effects, including long-term and late effects

You may find it helpful to bring a loved one with you to your doctor's visits for support and to take notes and ask follow-up questions. It's a good idea to prepare questions you'd like to ask when you visit your doctor. You can also record your conversations with your doctor and listen more closely when you get home.

To download lists of suggested questions to ask your healthcare providers, click here.

Pre-Treatment Testing

Before you start treatment, your doctor will perform tests to learn more about your overall health and your leukemia, including determining whether the leukemia has spread to other parts of the body. Doctors use this information for treatment planning.

Blood Tests

The following blood tests are used for treatment planning:

Complete Blood Count (CBC) with Differential
Blood Chemistery Profile
- Blood chemistry test findings indicate how well a person’s kidneys, liver and other organs are working.
Liver Function Tests
Coagulation Tests
- These tests measure the blood’s ability to clot and stop injuries from bleeding.
TLS Panel
- Patients with ALL may be at high risk for developing a life-threatening condition called “tumor lysis syndrome” (TLS). A TLS panel can help your doctor assess if you are likely to get TLS or if you already have it.
HLA Typing
- This consists of a blood test to identify certain proteins, called human leukocyte antigens (HLAs), found on the surface of most cells in the body. HLA typing is done before allogeneic stem cell transplantation to find out if there is a tissue match between the donor.

Spinal Fluid Test

The following test examines the fluid in the spinal column for ALL cells.

Lumbar Puncture. Acute lymphoblastic leukemia can spread to the cerebrospinal fluid (CSF), the fluid that flows around the brain and spinal cord. In order to determine whether or not leukemia cells have spread to this area, a sample of the CSF is tested. A lumbar puncture (also called a “spinal tap”) is a procedure that is used to collect the CSF from the spinal column. After the area over the spine in the lower part of the back has been numbed with a local anesthetic, a thin needle is inserted between two bones (vertebrae) and into the CSF. A sample of the fluid is withdrawn and examined under a microscope to look for leukemia cells that may have spread to the brain and spinal cord.

Imaging Tests

These tests create images of the inside of the body.

Computed Tomography (CT) Scan
- At times, leukemia may grow outside the bone marrow—most commonly in lymph nodes. A CT scan may be used to look for enlarged lymph nodes, liver or spleen caused by an accumulation of leukemia cells in the chest, abdomen and pelvis.
Positron Emission Tomography (PET) Scan
- A PET scan may be used to see if there are cancer cells in the lymph nodes or organs.
Positron Emission Tomography-Computer Tomography (PET-CT) Scan
- This procedure combines images from both a PET scan and CT scan.
Magnetic Resonance Imaging (MRI) Scan
- An MRI scan of the head and/or spinal cord should be done if a patient has symptoms (such as headache or seizures) that suggest that ALL cells may have spread to the brain and spinal cord.
Ultrasound
- This procedure uses high-energy sound waves to examine tissues and organs inside the body. Testicular involvement can occur so an ultrasound examination of the scrotum (the external sac that contains the testicles) may be needed to see if a mass is present.
Echocardiogram
- A computerized image of the heart is created by bouncing sound waves (ultrasound) off internal tissues or organs of the chest. An echocardiogram shows the heart’s size, shape and position as well as its internal structures. It also shows how the heart is beating and how it is pumping blood. Some treatments for ALL can damage the heart so the doctor may want to evaluate a patient’s heart and cardiac function in order to plan the best treatment.

Pretreatment Considerations

Adults of childbearing age should ask the doctor for information about addressing the risk of infertility. See the free LLS publication Fertility Facts for more details.