Acute Lymphocytic Leukemia Treatment

Penn hematologists and medical oncologists are part of large multidisciplinary teams whose approach to cancer and blood disorders is to treat the entire individual — not just the disease.

The following are possible treatments for people diagnosed with acute lymphocytic leukemia (ALL). Your treatment will depend on the sub-type of your ALL.

Treatment for Acute Lymphocytic Leukemia

Below are treatments for ALL.

Bone Marrow and Stem Cell Transplant

For many patients with ALL, an allogeneic bone marrow or stem cell transplant will be recommended.

An allogeneic transplant uses donor bone marrow or stem cells to replace the cells destroyed by the cancer treatment and bring in a new blood and immune system to help prevent the leukemia from coming back in the future. A series of special tests are performed to find a donor who is the best match for you. Typically the cells (stem cells) come from the bone marrow or the peripheral blood of the adult donor, although there are other sources of stem cells we consider when an adult donor is not available.

Allogeneic transplants are considered frequently in people with ALL. Not every person with ALL is a candidate for or needs an allogeneic transplant. Your overall health, and features of your disease, will affect the decision of having a transplant.

Allogeneic transplants are high-risk procedures. The decision to have a bone marrow or stem cell transplant should not be taken lightly.

About Our Bone Marrow and Stem Cell Program

Our bone marrow and stem cell transplant team are the same clinicians responsible for your overall treatment and care.

Other ways our bone marrow and stem cell transplant program are unique:

  • Our program is backed by a premier bone marrow and stem cell transplant research program that continues to make history in the development of new treatments through basic science research and clinical trials.
  • Penn has nationally recognized experts available to provide information, care, and support throughout the transplant process.
  • Our bone marrow and stem cell transplant program is one of the oldest and largest in the country, and has pioneered new therapies to treat blood cancers.
  • We have one of the few hematologic malignancy (leukemia, lymphoma and myeloma) research programs in the country that is approved and funded by the National Cancer Institute.
  • We have a dedicated hospital unit that is completely equipped to support transplant patients.
  • We have experienced nurses who understand the medical and personal issues patients face during transplant staff the unit.
  • We serve as medical advisors for area outreach organizations, such as the Multiple Myeloma Networking Group, and the Leukemia and Lymphoma Society.

Chemotherapy

Chemotherapy uses drugs to attack cancer cells, slowing or stopping their ability to grow and multiply.

Chemotherapy can be given:

  • Orally: taking pills or capsules by mouth
  • Intravenously (IV): injecting medication into a vein
  • Intramuscularly (IM): injecting medication into a muscle
  • Intrathecal (IT): injecting medication into the spinal fluid

Chemotherapy is not a "one-size-fits-all" cancer treatment. The wide range of cancer-fighting drugs attack different types of cancer cells at varying stages of cell development. Penn medical oncologists are experts at determining which drug or combination of drugs will be the most effective in treating the various types of cancer.

Clinical Trials

Clinical trials benefit patients with access to breakthrough therapies and treatments.

Because more and more treatments for leukemia and blood cancers are becoming available, it’s important to speak with your doctor about available clinical trials throughout your entire cancer treatment.

Cancer specialists at the Abramson Cancer Center are part of the Eastern Cooperative Oncology Group (ECOG), one of the largest clinical cancer research organizations in the nation.

Selina Luger, MD, director of the leukemia program at Penn Medicine, is co-chair of the Leukemia Committee at ECOG and cancer specialists from Penn are involved in the design of clinical trials to test novel therapies, new agents, or new treatment standards for people with leukemia.

Penn oncologists also participate in other national and institutional clinical trials. Being in a clinical trial offers you the opportunity to be treated with treatments, medications or agents that are not otherwise available. It also gives you the opportunity to be treated by, and have your case reviewed by experts who are directly involved with the design of the treatment.

Through clinical trials:

  • Diagnosing cancer has become more precise
  • Radiation and surgical techniques have advanced
  • Medications are more successful
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes
  • Strategies to address the late effects of cancer and its treatment have been developed to improve the quality of life

Immunotherapy

Immunotherapy is designed to repair, stimulate, or enhance the immune system's responses. Your immune system helps prevent disease, but it can also play a role in preventing cancer from developing or spreading. The goal of immunotherapy is to enhance the body's natural defenses and its ability to fight cancer.

Immunotherapy often has fewer side effects than conventional cancer treatments because it uses your own immune system to:

  • Target specific cancer cells, thereby potentially avoiding damage to normal cells
  • Make cancer cells easier for the immune system to recognize and destroy
  • Prevent or slow tumor growth and spread of cancer cells

About T-Cell Immunotherapy for Leukemia

T-Cell immunotherapy is an investigational treatment pioneered by the Penn team.

Here is an overview of how it works:

Your own immune cells (T-cells) are removed from the blood and genetically-modified or reprogrammed in the laboratory.

This modification or reprogramming allows the cells to potentially target and kill their own malignant cells. The modified cells (CTL019 cells) are then grown in the laboratory and re-infused into the patient.

When your own T-cells recognize and bind to the malignant cell, they have the ability to become activated and kill it.

Cells in the patient that do not express CD19 are left untouched by the modified T-cells, which limits the prolonged, systemic side effects typically experienced during traditional cancer therapies that harm healthy tissue.

Integrative Oncology and Wellness Programs

Our integrative oncology services can supplement traditional cancer treatments such as chemotherapy.

While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer you and your family ways to minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

We are knowledgeable of and support complementary cancer treatments. Our cancer teams work with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

Our integrative supportive services include:

Radiation Therapy

The following types of radiation therapy may be used for people with ALL.

Cranial Radiation

Some people with ALL may receive prophylactic (preventative) cranial radiation as part of their standard treatment.

Total Body Irradiation (TBI)

Radiation therapy is sometimes part of the transplant preparative regimen — treatment used to prepare a patient for bone marrow transplant. Total body irradiation (TBI) gives a dose of radiation to the whole body. TBI can destroy cancer cells throughout the body. It also destroys the immune system so that it will not attack the donor's cells during the transplant.

TBI can reach cancer cells within scar tissue or other areas of the body that chemotherapy may not reach. However, the dose of radiation must be low enough that the body's healthy cells can recover. For this reason, TBI alone cannot be used to destroy large numbers of cancer cells. Instead, the transplant preparative regimen uses TBI along with high-dose chemotherapy. (Some preparative regimens use only chemotherapy and do not include TBI.)

Targeted Molecular Therapy

Targeted molecular therapy at Penn Medicine is a type of personalized medical therapy designed to treat cancer by interrupting unique molecular abnormalities that drive cancer growth.

Targeted therapies are drugs that are designed to interfere with a specific biochemical pathway that is central to the development, growth, and spread of that particular cancer.

Identifying the molecular targets in any given patient's cancer requires working closely with pathologists to carefully analyze the cancer pathology. In some cancers, the molecular targets are known. But in other cancers these targets are still being identified. In some cases, the same types of cancer have different molecular targets. Targeted molecular therapy is personalized to you and your type of cancer.

Targeted cancer therapies such as targeted molecular therapy give medical oncologists a better way to customize cancer treatment. Advantages of molecularly targeted therapy include:

  • Potentially less harm to normal cells
  • Potentially fewer side effects
  • Improved effectiveness
  • Improved quality of life