As with all cancers, treatment for acute lymphocytic leukemia (ALL) is usually coordinated by a cancer care team, headed by a primary care physician and/or medical oncologist. For ALL, specialists may include a pediatrician, hematologist and radiation oncologist.

There are a variety of methods used to treat ALL. The exact treatment method chosen for each patient depends on the subtype of the leukemia. Certain prognostic factors also contribute to the treatment plan, including the patient’s age, white blood cell count, cytogenic test results and initial response to chemotherapy. Patients with ALL usually will be treated immediately and aggressively in order to destroy the cancer cells in the blood and bone marrow and put the leukemia in remission. Once signs and symptoms vanish, additional therapy may be given to prevent a relapse.

Since leukemia is a blood disorder and does not form tumors, surgery is not a form of treatment. Common treatment methods for ALL include:

• Chemotherapy. This treatment method uses powerful drugs to destroy cancer cells. It may be used to prevent the cancer from spreading to the brain and spinal cord. When used to treat ALL, a combination of drugs is given to the patient over a long period of time. Chemotherapy is the most common treatment method for ALL.
  
  
• Radiation therapy. Radiation therapy uses high-energy rays to destroy cancer cells and shrink tumors. It may be ordered to treat leukemia that has spread to the brain, spinal fluid or testicles. Radiation therapy may also be ordered before a patient undergoes a bone marrow or peripheral blood stem cell transplantation. On rare occasions, radiation treatment may be ordered as an emergency treatment to reduce the size of a mass pressing on the trachea.
  
  
• Bone marrow/stem cell transplantation. This method allows a patient to receive high levels of chemotherapy, radiation or a combination of both. Although the high dose treatment destroys the leukemia cells, it also destroys normal blood cells in the bone marrow. After the treatment, the patient receives an infusion of healthy stem cells through a vein. The stem cells may come from a matched donor or from the patients themselves. As a result, new blood cells begin to develop from the transplanted cells. This procedure is still fairly new and complex and cannot be used with all patients.

Patients with ALL will be treated according to the severity of their cancer. Since ALL is a cancer of the blood, the treatments are designed to treat the entire body. Chemotherapy is the primary treatment and provided in the following stages:

• Induction. This is the most aggressive stage. Its goal is to destroy as many cancer cells as possible and put the disease in remission. The patient usually receives a combination of chemotherapy drugs designed for the specific type of the disease.
  
  
• Consolidation. During this phase, different drugs are given to destroy those cells that remain after the induction phase. This phase also focuses on preventing the spread of cancer cells to other areas, particularly the central nervous system (CNS). If cancer cells are noted in the spinal fluid at this time, the patient may also receive radiation therapy to the brain and spinal cord (part of the CNS).
  
  
• Maintenance. This part of treatment is less intensive and may consist mainly of medications (pills) given at home. Occasionally, the patient may need to receive intravenous medications during this phase. The type of medication and dose will depend on the characteristics of the patient’s cancer. This phase of treatment may continue for about two years.

There are a number of terms that may be used to describe the status of ALL following treatment. These terms include:

• Relapse. The return of cancer after the initial treatment is known as relapse. A patient with more than 5 percent blast cells present in the bone marrow may be classified as being in relapse.
  
  
• Remission. Following treatment ALL may be classified as being in remission when:
  
  
• • The complete blood count is normal.
    
    
  • There are less than 5 percent blast cells in the bone marrow.
    
    
  • There are no signs or symptoms of the disease anywhere in the body.
    
    
• Active disease. In a patient who is newly diagnosed or in relapse, ALL will be classified as an active disease.
  
  
• Minimal residual disease. This term is used to describe a case of ALL when there is chemical evidence that cancer cells remain in the bone marrow, but there are not enough of the cells to be detected by routine examination under a microscope.

Patients may receive one method of treatment or a combination of treatments. After treatment, a patient may require regular visits to physicians for several years. Frequent checkups enable their physicians to detect any changes in health and treat them immediately. Checkups may include a physical examination, x-rays, blood tests, and other lab tests.

Patients are encouraged to report the development of any new symptoms to their physician. They may be a sign of recurrent ALL or side effects of treatment. If a relapse occurs, it typically occurs while patients are undergoing treatment, or shortly after they have completed chemotherapy. The disease can return in the blood, bone marrow, or other parts of the body. It is unusual for ALL to return if there are no signs of the disease five years after treatment.

The survival rate for patients with ALL has increased significantly since the 1970s, according to the American Cancer Society (ACS). From 1974 to 1978, the 5-year relative survival rate for an adult with ALL was 38 percent. From 1995 to 2001, that rate increased to 65 percent. For children under 15 years of age, the 5-year survival rate has increased to 87 percent. The improved survival rates are primarily due to advances in treatment of the disease.

Currently, there is no known method for preventing acute lymphocytic leukemia because it is not linked to preventable lifestyle risk factors.