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How We Treat Acute Lymphoblastic Leukemia

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

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  • How Is Acute Lymphoblastic Leukemia Treated?

    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. Our Program cares for a high number of patients with ALL and has expertise developing appropriate treatment plans based on age and ALL subtype.

    Treatment for ALL is determined by:

    • Your age
    • Your subtype of ALL (B cell or T cell, and if you have the Philadelphia chromosome)
    • Whether you are newly-diagnosed or your disease has relapsed
    • If a clinical trial is appropriate for your care

    Your care will include the latest and best treatments available, including clinical trials of new therapies based on research in our laboratories and elsewhere in the field. We have tailored treatment plans 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.

    Patients with ALL should begin treatment soon after their diagnosis. You can schedule your appointment with one of our leukemia specialists as soon as the next day. Call 617-632-6028 to schedule an appointment.

    Team Approach

    You receive world-class care from a team of specialists with expertise in caring for adults with ALL. We have extensive experience in standard and novel therapies to ensure that your care plan offers the best possible outcomes. We work closely with our stem cell/bone marrow transplant team when patients require transplantation to ensure early evaluation and a smooth and fast transition to transplantation. We also work closely with colleagues in pediatrics, social work, psychiatry, geriatrics, nutrition, and others to address the specific needs of each patient.

    Specialized Care for Adults of All Ages and Subtypes

    ALL is a rare disease with unique and complicated treatments. Our clinicians offer expertise in selecting treatment, monitoring response, and managing side effects for patients of all ages and disease subtypes.

    Young adult patients (ages 18-40 years): We believe all young patients with ALL should receive a pediatric-type chemotherapy regimen. Dana-Farber researchers pioneered this approach which has improved outcomes for adults aged 18 to 40 compared to what has historically been achieved using "adult" treatment protocols. We also recommend that all young patients enroll on a clinical trial when possible. One of our current clinical trials for young adults (17-717) explores the addition of a novel immunotherapy to pediatric-style chemotherapy.

    Older patients with ALL (>50-60 years): Older adults with ALL may experience more side effects from treatment. We have clinical trials studying novel, less-toxic approaches to treating ALL in older adults (18-170, 16-648). In addition, we work with our Older Adult Hematologic Malignancy Program which is a specialized research and clinical service that addresses the specialized needs of older blood cancer patients. 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.

    Philadelphia chromosome-positive ALL: This subtype of ALL is treated with a targeted therapy called a tyrosine kinase inhibitor (TKI). We offer a clinical trial of a novel TKI approach (18-170) for this disease subtype. Our team typically recommends that standard chemotherapy be reduced or omitted for this disease subtype. Patients with this subtype are often considered for stem cell transplant. We work closely with our stem cell/bone marrow transplant team to ensure early evaluation and a smooth and fast transition to transplantation when appropriate.

    Relapsed and refractory ALL: ALL that has come back or not responded to prior therapy can be a challenging disease to treat. Our experts have experience with this clinical situation and a number of trials are available testing novel therapies (17-731, 21-196) and CAR T-cells (20-272, 20-562).

    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.

    Reasons to consider a consultation or second opinion include:

    • If you have received a diagnosis elsewhere and want to be treated at Dana-Farber/Brigham and Women's Cancer Center. We offer next-day appointments to ensure there is no delay in starting treatment should you wish to be treated at our specialty center.
    • To learn if you're eligible for a clinical trial.
    • To confirm your diagnosis.
    • To determine the optimal therapy and timing of treatment.
    • To determine if you should consider allogeneic stem cell transplant.
    • 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.

    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

    If you are a physician and have a patient with diagnosed or suspected ALL, we have a leukemia physician on call to discuss newly-diagnosed ALL patients.

    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 may take two years or longer to complete.

    The treatment of adult ALL is usually done in phases:

    Remission Induction Therapy
    This first phase of treatment for newly-diagnosed ALL patients generally lasts 3 to 4 weeks. The specific treatment plan depends on age and ALL disease subtype, and may include chemotherapy, antibody-based immunotherapy, and/or a targeted therapy called a tyrosine kinase inhibitor (TKI). Patients are often admitted to the hospital for this phase of treatment. The goal of induction is to kill the leukemia cells in the blood and bone marrow to put the cancer into remission. After a patient achieves remission, we determine next steps for treatment based on your age, ALL disease subtype, and level of response to initial therapy (i.e. whether you have measurable residual disease or remaining cancer cells detected by our sensitive testing).

    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. Post-remission therapy generally involves chemotherapy, and may include immunotherapy, TKI, and/or allogeneic stem cell transplant.

    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 multiple spinal taps and administration of chemotherapy. Some patients may also receive radiation to the brain.

    Allogeneic Stem Cell Transplant
    Some patients require allogeneic stem cell transplant as part of their post-remission or consolidation treatment or as part of treatment for relapsed disease. With an allogeneic stem cell transplant, patients receive stem cells from a related or unrelated donor to develop a new immune system. In order to undergo a transplant, a patient typically needs to be in remission. If a patient has relapsed after initial treatment, more chemotherapy, novel cancer therapies, or immunotherapy is 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.

    Clinical Trials for Acute Lymphoblastic Leukemia

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

    • Newly-diagnosed patients
    • Relapsed patients
    • Young adults (18-40 years)
    • ALL with specific molecular characteristics such as Philadelphia chromosome-positive

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

    View some of our current clinical trials for ALL.

    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.

    Your Care

    One of our experienced leukemia physicians will oversee all aspects of your care, both inpatient and outpatient.

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

    If you need to be hospitalized during your care, or if you undergo allogeneic 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.