Adult Acute Lymphoblastic Leukemia
Adult ALL is a malignant disease or cancer of the blood characterized by the rapid uncontrolled growth of abnormal, immature white blood cells known as lymphoblasts. There are approximately 5,000 new cases of Adult ALL each year in the US with approximately 1500 deaths.
There has been significant progress in treating adult ALL over the past two decades and currently 60-80% of patients will achieve a complete remission following combination chemotherapy induction and 30-40% will become long-term survivors and possibly cured. This progress has been made possible by the development of effective multi-agent chemotherapy regimens; the development of Gleevec® (imatinib), which is effective in Philadelphia chromosome-positive ALL; improvements in supportive care with growth factors such as Neupogen® (Filgrastim) and Neulasta® (pegfilgrastim); and improvements in allogeneic stem cell transplantation. The development of cytogenetic and molecular tests can now better define prognostic groups allowing for individualized treatment regimens for patients with high- and low-risk features.
A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.
The following is a general overview of the treatment of adult ALL. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials. Information about National Cancer Institute sponsored protocols for ALL can be obtained at cancer.gov
Protocols sponsored by the National Cancer Institute are carried out by cooperative groups in the U.S. These groups have protocols for all phases of treatment of ALL and include:
- Cancer and Leukemia Group B (CALGB): https://www.calgb.org/
- Eastern Cooperative Oncology Group (ECOG): https://www.ecog.org/
- Southwest Oncology Group (SWOG): https://www.swog.org/
Treatment of adolescents and very young adults with ALL is often carried out using pediatric protocols because of data suggesting better outcomes for this group than when treatment is administered on adult protocols.1 Treatment of children with ALL, including adolescents and young adults, is included in a separate section. Go to: Childhood Acute Lymphoblastic Leukemia.
In order to understand the best treatment options available for adult ALL, patients should know whether they have a B-cell or T-cell leukemia, the classification or histologic subtype (L1-L3) of leukemia, the initial white blood cell count, and the results of analyses of chromosomes by cytogenetic examination. These are all tests that are performed on a sample obtained from the bone marrow. Adult ALL is frequently associated with abnormal chromosomes of the leukemia cells. Knowing the specific chromosomal abnormalities associated with your leukemia can be important for treatment planning as some are associated with a relatively good prognosis and others with a worse-than-average prognosis with standard treatment. More recently, molecular testing has been found to be more accurate than cytogenetics in detecting abnormalities that affect outcome.2 It is important to identify patients with Philadelphia chromosome-positive ALL because there are drugs which are only effective for this subset of adults with ALL. However, this subset of patients represents up to 40% of all elderly patients with ALL.
The treatment of adult ALL occurs in two phases. The initial treatment phase is called remission induction. The goal of remission induction therapy is to achieve a complete remission or disappearance of all detectable leukemia cells in bone marrow, peripheral blood and other sites such as the testes and central nervous system (CNS). After a complete remission is achieved, the second phase of treatment, called post-remission therapy, begins. Post-remission therapy is necessary because despite achieving a complete remission of leukemia with induction treatment, hidden undetectable leukemia cells still exist and the leukemia will return without additional post-remission therapy. Post-remission therapy is often referred to as consolidation.
1 Boissel N, Auclerc M-F, Lhéritier V, et al. Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials. Journal of Clinical Oncology. 2003;21:774-780.
2 Chiaretti S, Li X, Gentleman R, et al. Gene expression profiles of B-lineage adult acute lymphocytic leukemia reveal genetic patterns that identify lineage derivation and distinct mechanisms of transformation. Clinical Cancer Research 2005;11:7209-7219.
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