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How We Treat Acute Lymphoblastic Leukemia

  • Jacqueline Garcia, MD, on treating acute leukemias in adults

  • Our Unique Approach

    The Adult Leukemia Program is part of Dana-Farber/Brigham and Women's Cancer Center's Center for Hematologic Oncology, one of the world's largest and most respected treatment centers for patients with disorders of the blood or bone marrow.

    Your care will include the latest and best treatments available, including new therapies based on research in our laboratories and elsewhere in the field of leukemia treatment. We have tailored protocols for both young adults and older adults. You also have the full range of support services from a top-ranked hospital and leading cancer research center.

    Team Approach

    You receive world-class care from a full array of specialists with years of expertise in caring for adults with ALL. These experts manage your care as a close-knit team in order to decide what approach will best treat your condition. They have extensive experience in standard therapies and emerging therapies to ensure that your care plan offers the best possible outcomes based upon your type of leukemia. We work closely with our transplant service team when patients require bone marrow/stem cell transplantation to ensure a smooth and fast transition to transplantation when appropriate.

    Personalized Treatment

    As a highly specialized Center within DF/BWCC's Center for Hematologic Oncology, we focus on the distinct needs of patients with leukemia. We provide a very personalized approach to your care.

    We view every patient as an individual, with unique needs and expectations. We involve you and your family at each step of the treatment process. As you go through treatment, you and your family will have access to a wide range of support resources — from nutrition services to integrative therapies, and much more.

    Specialized Care for Adults of All Ages

    Our Older Adult Hematologic Malignancy Program is a specialized research and clinical service that addresses the specialized needs of blood cancer patients aged 75 and older. Geriatricians work closely with oncologists to create individualized treatment plans for older adults to help manage other medical conditions or frailty a patient may have. These patients may participate in research protocols tailored to older adults, including clinical trials and tissue banking efforts.

    We have also pioneered a new direction in treatment of younger adults (aged 18 to 40) with ALL, using a pediatric-like chemotherapy regimen. This approach results in improved outcomes for adults aged 18 to 40 compared to what has historically been achieved using "adult" treatment protocols.

    Offering Expertise through Consultations and Second Opinions

    • Because adult acute lymphoblastic leukemia is relatively uncommon, we believe there is great value in adults with suspected or diagnosed ALL consulting with our team of experienced clinicians.
    • We routinely evaluate specimens sent to us from outside centers. These specimens are evaluated by our entire team, including our expert hematopathologists.

    Reasons to consider a consultation or second opinion include:

    • To confirm your diagnosis.
    • If you have received a diagnosis elsewhere and want to be treated at Dana-Farber/Brigham and Women's Cancer Center.
    • To determine the optimal therapy and timing of treatment.
    • To learn more about your cancer from specialists who are world leaders in this disease, and who have treated hundreds of other patients like you.
    • To learn if you're eligible for a clinical trial.

    Phone: 617-632-6028 or 617-632-5138

    Online: Complete the Appointment Request Form.

    If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service.

    For Referring Physicians

    Because you, the referring physician, are an integral part of your patient's care team, we are committed to collaborating with you to provide the best care for your patient.

    If you are a physician and have a patient with diagnosed or suspected AML, we look forward to working with you. Learn how to refer a patient.

    Our Treatment Approach

    Treatment for ALL is often a long-term process. Chemotherapy and other treatment for this disease may take two years or longer to complete. A distinguishing area of our expertise is evaluating how well you respond to each therapy through sensitive testing, and to adjust treatment regimens accordingly.

    The treatment of adult ALL is usually done in phases:

    Remission Induction Therapy
    This first phase of treatment for newly-diagnosed patients generally lasts 3 to 4 weeks. Patients are admitted to the hospital for this phase of treatment. The goal is to kill the leukemia cells in the blood and bone marrow to put the cancer into remission. If patients go into remission, we look at the level of response to therapy, as well as molecular and chromosomal tests to help determine optimal treatment, including a stem cell transplant.

    Post-Remission Therapy (also called consolidation and maintenance therapy)
    Leukemia cells may remain after achieving an initial remission. Therefore, the goal in this phase — which generally lasts for up to two years — is to eliminate remaining leukemia cells that may not be active but could begin to regrow, usually using chemotherapy.

    Central Nervous System Prophylaxis
    Because ALL cells can migrate to the brain or spinal cord, special treatment must be administered to prevent ALL from recurring in this area. Treatment typically consists of a spinal tap and administration of chemotherapy. Often, patients will receive radiation to the brain, as well.

    Treatment of ALL may include the following:

    Chemotherapy
    Chemotherapy is a drug treatment that interferes with the cancer cell's ability to grow or reproduce. Intrathecal chemotherapy may be used to treat ALL that has spread, or may spread, to the brain and spinal cord.

    Targeted Therapy
    Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Targeted therapy drugs called tyrosine kinase inhibitors (TKIs) may be used to treat some types of adult ALL, such as those associated with the Philadelphia chromosome.

    Radiation Therapy
    Radiation therapy uses high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors. External radiation therapy (using a machine outside the body to send radiation toward the cancer) 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) therapy or CNS prophylaxis.

    Stem Cell Transplant
    Some patients require stem cell transplant as part of their initial treatment or as part of treatment for relapsed disease. With a stem cell transplant, patients receive a new immune system from a related or unrelated donor. In order to undergo a transplant, a patient needs to be in remission. If a patient has relapsed after initial treatment, more chemotherapy or immunotherapy is typically used to achieve a second remission.

    Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) has one of the largest and most experienced stem cell transplantation programs in the country.

    Investigational Approaches

    The Adult Leukemia Program operates a large and growing research program. We are actively engaged in leukemia clinical trials, leading to new therapies and aiming for eventual cures. Our clinical team works closely with our leukemia researchers to develop new treatments based on the latest scientific discoveries.

    We are also exploring CAR T-cell therapy for patients who have relapsed after intensive chemotherapy or a stem cell transplant.

    Your Care

    You will be assigned to one of our leukemia physicians as your primary oncologist overseeing all aspects of your care, both inpatient and outpatient.

    All outpatient therapy is provided at the Yawkey Center for Cancer Care at Dana-Farber Cancer Institute, one of the most advanced outpatient cancer centers in the country.

    If you need to be hospitalized during your care, or if you undergo stem cell transplantation, you will be admitted to Brigham and Women's Hospital (BWH) or the Dana-Farber Inpatient Hospital located within BWH. Your primary oncologist and nurse will closely monitor your care and will coordinate your care with the inpatient team and additional specialists, who will address any other symptoms you may be experiencing. This model ensures seamless care from the outpatient to the inpatient setting. Learn more about your stay.