Adult ALL Therapy: What to Expect

Treatment for acute lymphoblastic leukemia can be long and difficult at times, but the end goal is curing the disease.

Acute lymphoblastic leukemia (ALL) is one of the most common childhood cancers, but is much rarer in adults, who tend to have poorer outcomes. Ongoing research and new treatment regimens are looking to change that.

“Pediatric patients less than 15 years old … will do very well, with a high cure rate of 80 to 90%. That’s where we want to be for the older patients, too,” said Dr. Jae H. Park, associate attending physician and director of the Adult ALL Program at Memorial Sloan Kettering Cancer Center.

Park recently presented on ALL updates at the CURE® Educated Patient® Leukemia Summit and gave an overview of what patients with ALL can expect regarding their treatment plan.

Older patients have a higher risk for genetic mutations – such as low hypodiploid, Philadelphia-like chromosome mutations and KMT2A – which is associated with a decreased response to chemotherapy. Park emphasized that it is important for patients and their clinicians to know about their genetic mutations status before deciding on and starting a treatment regimen.

Treating ALL

ALL treatment starts with one to two months of induction chemotherapy, which is the first line of chemotherapy given with the goal of completely getting rid of the leukemia cells. If this step is successful, there should be no leukemia cells detected in the bone marrow.

Next comes a step called consolidation.

“Even if we have successfully eradicated the leukemia, we still have to continue the chemotherapy to maintain the remission,” Park said. Depending on the type of regimen prescribed, this step takes about six to eight months.

“Once you’re done with these two, you’re also not finished. Then you have to do maintenance chemotherapy, which is oral chemotherapy, which is much easier,” Park said. “This is actually the time that patients do return to their normal life routine and their work. But it is still a continuation of chemotherapy and about two years long.”

Stem Cell Transplants and Salvage Therapy

If a patient’s disease does not respond well to the earlier rounds of chemotherapy, the patient and their treatment team might consider a stem cell transplant. However, it is still important that as much disease as possible is eradicated before undergoing the transplant. This could involve salvage or re-induction therapy, which is given with the goal of a complete remissions before stem cell transplantation.

“If you do go to stem cell transplant, you do not need to do consolidation and maintenance chemotherapy after,” Park said. “But there are other specific follow-ups that are required after a stem cell transplant, which still takes about six to eight months for a full recovery.”

Side Effects of ALL Treatment

Since patients with ALL who are undergoing chemotherapy usually have low white blood cell counts, infection is a common risk. Additionally, chemotherapy can impact heart function and bone health or even lead to secondary cancers.

However, Park encouraged patients to remember why they are going through the treatment process, though it can be difficult at times.

“It’s important to note that the goal of this therapy – even though it’s a laborious process – is cure for the vast majority of patients,” he said. “So we tend to take a little bit higher risk when we can to accomplish that goal.”

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