Acute Lymphoblastic Leukemia (ALL) Treatments and Therapies

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Today, there are more treatment options than ever before to put acute lymphoblastic leukemia (ALL) into remission. Unlike many other cancers, ALL is both treatable and curable, so there is plenty of reason for hope.

Acute Lymphoblastic Leukemia Care Tailored to You

You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.

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Your ALL Treatment Plan

Treatment for ALL is different for each person. You physician will consider every detail related to your disease when recommending treatment:

  • Your ALL subtype and classification
  • Your overall health
  • Your lifestyle
  • Your preferences

With support from your care team, your physician will figure out if there is anything special to consider because of your subtype and classification, explain the standard therapy for your subtype and tell you about clinical trials that may match your needs.

Treatment Process

Different subtypes of ALL progress and respond to treatments in different ways. We choose, combine and schedule your treatments based on what works for your subtype and how your body responds. Your care team will make sure you understand each type of treatment and all of your choices.

Standard Therapy

Treatment for ALL is complex. It is usually done in three phases.

Phase 1: Induction Therapy

Because ALL progresses so quickly, intense treatment to put the disease in remission often starts very soon after diagnosis — sometimes within hours or just a few days. This means getting a combination of chemotherapy along with a steroid during an inpatient (overnight) stay at UW Medical Center – Montlake that lasts for a few days.

After your initial hospital visit, we know you’d rather be in the comfort of your own home. So we provide as much of your care as possible as an outpatient. We offer infusion services 365 days a year at the Fred Hutch Sloan Clinic so you can stay at home instead of at the hospital.

Phase 2: Consolidation Therapy

About 80% of people with newly diagnosed ALL enter remission (the disease goes away) after induction therapy. Next, we do consolidation therapy to prevent a relapse (the disease coming back). This involves chemotherapy, steroids and targeted therapy and usually lasts a few weeks to a few months.

If your ALL does not respond well to induction therapy, your physician will recommend different treatments. If this happens, or if your leukemia has some features that might be harder to treat, your physician may also recommend a blood and marrow transplant — a treatment that our own physicians and scientists pioneered.

Phase 3: Maintenance Therapy

If you’re in remission, you will go on maintenance therapy to lower the risk of a recurrence.

This phase may last a few years. It often involves lower doses of chemotherapy and targeted therapies. It's still treatment, but patients can usually go back to their normal lives during this phase.

Ryan Cassaday

“My goal is to find the best strategy for each individual patient I see, with the hope of providing the best balance of quality and quantity of life that I can.”

— Dr. Ryan Cassaday, hematologist-oncologist and ALL specialist

How We Treat ALL at Fred Hutch

At Fred Hutch, we offer all standard therapies. Your first appointment with us usually takes one to two hours.

Chemotherapy

Most people with ALL start by getting intense chemotherapy and follow up with more treatments of phased chemotherapy.

Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing (which is how cancers grow). Chemotherapy drugs are usually given through an intravenous (IV) line in repeating cycles every two to six weeks.

Your care team will talk with you about which drugs we recommend for you, how you will take them, your treatment schedule and what to expect. We will also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout Fred Hutch.

Some of the chemotherapy drugs that are used most often to treat ALL are:

  • Cyclophosphamide
  • Cytarabine
  • Doxorubicin or daunorubicin
  • Mercaptopurine
  • Methotrexate
  • Nelarabine
  • Pegaspargase
  • Vincristine

Targeted Therapy

For some subtypes or classifications of ALL, you may get targeted therapies. These therapies are newer cancer treatments that are more exact than standard chemotherapy.

Targeted therapies work in one of three ways:

  1. They target a gene or protein that causes cancer growth.
  2. They damage cancer cells directly.
  3. They tell your immune system to attack certain cells. This is also called immunotherapy.

Immunotherapy

Immunotherapies are some of the latest innovations in ALL care. They use the power of your immune system to fight your cancer.

For ALL that has come back or didn’t respond to other treatments (relapsed or refractory ALL), your physician may recommend a form of treatment that uses your immune system, such as:

  • Blinatumomab, a type of antibody therapy that helps your body’s T cells recognize and destroy cancerous B cells
  • Tisagenlecleucel (Kymriah) or brexucabtagene autoleucel (Tecartus), or CAR T-cell therapy

Fred Hutch is one of the first cancer centers in the nation to offer FDA-approved cellular immunotherapy for ALL. Tisagenlecleucel (Kymriah) and brexucabtagene autoleucel (Tecartus) are two different CAR T-cell therapies available only at certified treatment centers.

Learn More About Immunotherapy

Blood and Marrow Transplant

For ALL, most people who have a transplant get stem cells from a donor. This is called an allogeneic transplant, and it works in two ways:

  1. After you receive strong chemotherapy to get rid of the ALL, the donor’s healthy stem cells restart your body’s ability to make blood cells.
  2. White blood cells from the donor may recognize any leukemia cells that are still in your body and attack them.

More people are eligible for allogeneic transplants than ever before, because of advances available at Fred Hutch, including:

  • Non-myeloablative (lower-intensity) transplants, which use lower-dose chemotherapy
  • Transplants using stem cells from donated umbilical cord blood or haploidentical (half-matched) donors

Sometimes, physicians transplant the patient’s own stem cells, which were taken out earlier and had the leukemic cells removed (autologous transplant). However, this doesn’t happen very often with ALL.

Learn More About BMT

Monitoring Your Health During ALL Treatment

While you’re in active treatment, your ALL care team will see you regularly for exams and tests to check:

  • How well your treatment is working
  • If there’s any reason to change your treatment
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling

We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.

Possible Results of Treatment

Throughout treatment, your care team looks for signs of:

  • Remission: Fewer signs and symptoms of cancer. Partial remission means some signs and symptoms remain. Complete remission means there are no signs or symptoms.
  • Disease progression: The disease is getting worse or spreading.
  • Relapse: The disease, signs or symptoms have come back after they had improved.
  • Refractory disease: The disease does not respond to treatment. 

What about “cured”? Sometimes physicians use the word cured if you have been in complete remission for at least five years. After five years, cancer is less likely to come back (recur), but recurrence is still possible.

Fred Hutch offers a wide range of support and resources for caregivers.

View Information for Caregivers

Continuing Care

When your disease is in remission and your active treatment ends, it’s still important to get follow-up care on a regular basis. At follow-up visits, you’ll see the same team who treated your ALL. They will check:

  • For signs that your disease has come back
  • If you need help with long-term side effects
  • If you need help with late effects
  • Your overall health

Schedule for Follow-up Visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your hematologist-oncologist will schedule your follow-ups based on many things, including:

  • Your ALL subtype
  • Which treatments you had and how your disease responded
  • How the disease and treatments affected you
  • How long it’s been since your treatment ended 

Most patients are followed for at least five years for ALL. It’s common to have visits more often at first and then less often later. This will depend on your exact needs.

What Happens at Follow-up Visits

Follow-up for ALL usually means seeing your hematologist-oncologist for a physical exam and having blood tests to check your blood cell levels. If there are any changes, you might have tests to check the health of your bone marrow.

Your physician will let you know if you need any imaging tests. You might have tests like a CT (computed tomography) scan or PET (positron-emission tomography) scan. These can help check for recurrence (if the cancer has come back), but they also expose you to some radiation. Together, you and your physician will decide on the benefits and risks.

Why Choose Fred Hutch for ALL Treatment

At Fred Hutch, we understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.  

Team-Based Care from Specialists

Fred Hutch has hematologist-oncologists and pathologists who specialize in ALL, as well as transplant oncologists if you need them. We offer the most advanced diagnostic, treatment and recovery programs. Along with treating your cancer, we also offer a range of services to support you and your caregiver. This is part of how we take care of you — not just your disease. From registered dietitians to Spiritual Health clinicians to social workers, our experts know how to care for people with ALL.

Treatment Tailored to You

We view treatment as a collaborative effort. Your Fred Hutch physicians will explain all your options. We’ll recommend a treatment plan to get you the best results based on the subtype of your cancer, the treatment’s potential side effects, as well as your age and overall health. We provide all standard therapies.

Clinical Trials to Improve Outcomes

Many of our patients receive promising therapies by taking part in ALL clinical trials. These research studies are done by physician-scientists from Fred Hutch and UW Medicine. They test new treatments or new ways to use current treatments. Every advance in cancer treatment in recent years has come out of clinical trials. By doing trials, we can offer more treatment options for people like you.

ALL Treatment FAQ

Side effects are different depending on which treatment you receive. They also depend on other things, like how strong your immune system is. These are some of the common side effects of ALL treatment:

  • Higher risk of infection (due to low levels of white blood cells) 
  • Low numbers of red blood cells (anemia), which can cause unusual tiredness (fatigue) and is treated with transfusions 
  • Low numbers of platelets, which can cause bruising and bleeding and is treated with transfusions 
  • Mouth sores 
  • Diarrhea 
  • Hair loss 
  • Nausea 
  • Vomiting 
  • Headache 
  • Rash or other skin changes 
  • Numbness, tingling or pain from nerve damage (neuropathy) 

ALL treatment can also have long-term effects, like fatigue, and late effects (that start long after treatment ends), like heart disease. Not everyone who is treated for ALL develops long-term or late effects. It often depends on your age, overall health and your specific treatment. But no matter if or when late side effects show up, we’re here to help.

Before you begin treatment, we talk with you in advance about what to expect, based on your treatment plan, and what can help if you do have side effects.

At your appointments, we want you to tell us about any side effects you are having. If you have questions or concerns between appointments, you can call or email us. We will make sure you know how to reach care providers at Fred Hutch after hours, if that’s when you need us.

We have many tools to help you feel better, such as:

  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections 
  • Transfusions, steroids and medicines that help the immune system treat low levels of blood cells (low blood counts) 
  • Nutrition care and medicines to help with digestive problems 
  • Conventional and integrative therapies for pain 

The Fred Hutch Patient Education team has video resources that go over how to keep common side effects at bay.