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Adult Acute Lymphoblastic Leukemia
Summary Type: Treatment
Summary Audience: Patients
Summary Language: English
Summary Description: Expert-reviewed information summary about the treatment of adult acute lymphoblastic leukemia.
Adult Acute Lymphoblastic Leukemia
General Information About Adult Acute Lymphoblastic Leukemia
Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which
the bone
marrow makes too many lymphocytes (a type of white blood cell).
Adult acute lymphoblastic leukemia (ALL; also called acute lymphocytic
leukemia) is a cancer of the blood and bone marrow . This type of cancer usually gets worse quickly if it is not treated.
Normally,
the bone marrow makes stem cells (immature cells ) that develop into mature blood cells. There are 3 types of mature blood cells:
In ALL , too many stem cells develop into a type of white blood cell called lymphocytes . These lymphocytes may also be called lymphoblasts or leukemic cells. There are 3 types of lymphocytes:
In ALL, the lymphocytes are not able to fight infection very well. Also, as the number of lymphocytes increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may cause infection , anemia , and easy bleeding. The cancer can also spread to the central nervous system (brain and spinal
cord ).
This summary is about adult acute lymphoblastic leukemia.
Refer to the following PDQ summaries for information on other types of leukemia:
- Childhood Acute Lymphoblastic Leukemia Treatment.
- Adult Acute Myeloid Leukemia Treatment.
- Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment.
- Chronic Lymphocytic Leukemia Treatment.
- Chronic Myelogenous Leukemia Treatment.
- Hairy Cell Leukemia Treatment.
Previous chemotherapy and exposure to radiation may increase the risk of developing ALL.
Anything that increases your risk of getting a disease is called a risk factor . Possible risk factors for ALL include the following:
Possible signs of adult ALL include fever, feeling tired, and easy bruising or bleeding.
The early signs of ALL may be similar to the flu or other common diseases.
A doctor should be consulted if any of the following problems occur:
- Weakness or feeling tired.
- Fever.
- Easy bruising or bleeding.
- Petechiae (flat, pinpoint spots under the skin caused by bleeding).
- Shortness of breath.
- Weight loss or loss of appetite.
- Pain in the bones or stomach .
- Pain or feeling of fullness below the ribs.
- Painless lumps in the neck, underarm, stomach, or groin .
These and other symptoms may be caused by adult acute lymphoblastic
leukemia or by other conditions.
Tests that examine the blood and bone marrow are
used to detect (find) and diagnose adult ALL.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease , such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
- Complete blood
count (CBC): A procedure in which a sample of blood is drawn and
checked for the following:
- The number of red blood cells, white blood cells, and
platelets.
- The amount of hemoglobin (the protein that carries oxygen) in
the red blood cells.
- The portion of the blood sample made up of red blood
cells.
- Peripheral blood smear : A procedure in which a sample of blood is checked for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.
- Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.
- Cytogenetic analysis: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are certain changes in the chromosomes in the lymphocytes. For example, sometimes in ALL, part of one chromosome is moved to another chromosome. This is called the Philadelphia chromosome .
- Immunophenotyping : A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant (cancerous) lymphocytes began from the B lymphocytes or the T lymphocytes.
Certain factors affect prognosis (chance
of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The age of the patient.
- Whether the cancer has spread to the brain or spinal cord.
- Whether the Philadelphia chromosome is present.
- Whether the cancer has been treated before or has recurred (come back).
Stages of Adult Acute Lymphoblastic Leukemia
Once adult ALL has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system (brain and spinal cord) or to other parts of the body.
The extent or spread of cancer is usually described as stages . It is important to know whether the leukemia has spread outside the blood and bone marrow in order to plan treatment. The following tests and procedures may be used to determine if the leukemia has spread:
- Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Lumbar puncture : A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
- Ultrasound : A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs in the abdomen and make echoes. The echoes form a picture of body tissues called a sonogram .
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
There is no standard staging system for adult ALL.
The disease is classified as untreated, in remission , or recurrent .
Untreated adult ALL
The ALL is newly diagnosed and has not been treated except to relieve symptoms such as fever , bleeding, or pain.
Adult ALL in remission
The ALL has been treated.
Recurrent Adult Acute Lymphoblastic Leukemia
Recurrent adult acute lymphoblastic leukemia (ALL) is cancer that has recurred (come back) after
going into remission . The ALL may come back in the blood , bone
marrow , or other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with adult
ALL.
Different types of treatment are available for patients with adult
acute lymphoblastic leukemia (ALL). Some treatments are standard (the currently used treatment), and some are
being tested in clinical trials . A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer .
When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the
NCI Web
site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
The treatment of adult ALL usually has 2 phases.
The treatment of adult ALL is done in phases:
- Remission induction therapy : This is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow . This puts the leukemia into remission .
- Maintenance therapy : This is the second phase of treatment. It begins once the leukemia is in remission. The purpose of maintenance therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse . This phase is also called remission continuation therapy.
Treatment called central nervous system (CNS) sanctuary therapy is usually given during each phase of therapy. Because chemotherapy that is given by mouth or injected into a vein may not reach leukemia cells in the CNS (brain and spinal cord ), the cells are able to find "sanctuary" (hide) in the CNS. Intrathecal chemotherapy and radiation therapy are able to reach leukemia cells in the CNS and are given to kill the leukemia cells and prevent the cancer from recurring (coming back). CNS sanctuary therapy is also called CNS prophylaxis.
Four types of standard treatment are used:
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy ). When chemotherapy is placed directly into the spinal column , an organ , or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas (regional chemotherapy ). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Intrathecal chemotherapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used to prevent cancer from spreading to the brain and spinal cord, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis. Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , wires, or catheters that are placed directly into or near the cancer. External radiation therapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used this way, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis.
Chemotherapy with stem cell transplant
Stem cell transplant is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion . These reinfused stem cells grow into (and restore) the body's blood cells.
Tyrosine kinase inhibitor therapy
Anticancer drugs called tyrosine kinase inhibitors are used to treat some types of adult ALL.
These drugs block the enzyme , tyrosine kinase, that causes stem cells to develop into more white blood cells (blasts ) than the body needs. Two of the drugs used are imatinib mesylate (Gleevec) and dasatinib .
New types of treatment are being tested in clinical trials.
These include the following:
Biologic therapy
Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web
site.
Treatment Options for Adult Acute Lymphoblastic Leukemia
Untreated Adult Acute Lymphoblastic Leukemia
Standard treatment of adult acute lymphoblastic leukemia (ALL) during the remission induction phase includes the following:
Adult Acute Lymphoblastic Leukemia in Remission
Standard treatment of adult ALL during the maintenance phase includes the following:
Recurrent Adult Acute Lymphoblastic Leukemia
Standard treatment of recurrent adult ALL may include the following:
Some of the treatments being studied in clinical trials for recurrent adult ALL include the following:
- A clinical trial of stem cell transplant using the
patient's own stem cells .
- A clinical trial of biologic therapy .
- A clinical trial of new anticancer drugs .
Information about these and other ongoing clinical trials is available from the
NCI Web
site.
Changes to This Summary (02/28/2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
To Learn More
Call
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
2007-02-28
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