Treatment of ALL
Treatment of ALL is very complex and time consuming. Chemotherapy and Radiation therapy are the most important methods of treating this illness.
There are four stages of treatment for ALL
- Remission induction
- Treatment of central nervous system
- Consolidation or Intensification therapy
- Maintenance therapy, prevention of recurrence of the leukemia
Purpose of the first run of chemotherapy is to make the disease to go away, so called to induce a "Remission". This goal is achieved when the blood counts have normalized and there is no evidence of leukemia in the blood or bone marrow. This portion of treatment may last from 1 to 3 months. About 80% to 85% of patients achieve a complete response with aggressive chemotherapy, however the disease will come back shortly after if no further chemotherapy is used. The reason is that some leukemia cells are left behind and can not be detected or seen under microscope.
Central Nervous System
(brain) is a site that chemotherapy drugs can not penetrate. This part of body, as a result, becomes a reservoir for leukemia cells. Without adequate treatment, up to two thirds of ALL patients will have a leukemic relapse in their brain. Common approaches to this problem are: Radiation therapy to brain and spinal canal and injection of chemotherapy drugs, Methotrexate or Ara-C, into the Spinal Fluid using a Lumbar Puncture. This portion of treatment is synchronized with the rest of chemotherapy in the first few months of treatment.
Usage of intensive and aggressive chemotherapy after induction of remission reduces the rate of recurrence of ALL. This portion of treatment may last a few months.
Maintenance therapy
After completion of all of the above treatments, patients are placed on maintenance treatment with oral medications as well as intravenous chemotherapy drugs. Length of this treatment is normally two years.
Different institutions may use different programs for each phase of this treatment. Following is a list of most commonly used drugs in various stages of ALL:
Vincristine, Prednisone, L-Asparaginase, Daunorubicin, Adriamycin, Methotrexate, 6-Mercaptopurine, Cytoxan, Ara-C, VP-16, Teniposide, Mitoxantrone
Certain patients are treated with Bone Marrow Transplantation:
- Patients with high risk ALL
- Patients who do not enter a remission
- Patients who have an identical twin
- Patients who relapse soon after initial remission
