You may have a question about what is the acute lymphocytic leukemia? And how does it treat? So, it is a part of cancer like there are so many different types of cancer like carcinoma, sarcoma, leukemia and many more. Leukemia also has many parts and one of them is acute lymphocytic leukemia. It is a very common cancer in children, it affects kids aged 2 to 5, but ALL also occurs in adults. The most common and main treatment is chemotherapy for acute lymphocytic leukemia. It is a three phases treatment and it is treated with the help of drugs. In this blog, we will explain about chemotherapy and the phases of chemotherapy for acute lymphocytic leukemia. The drugs that are used to treat it and their side effects.
What Is Acute Lymphocytic Leukemia?
Acute lymphocytic leukemia is a very unique blood cancer that affects the lymphocytes which are a type of white blood cell. It develops and spreads in the bone marrow all over the body. This is a serious condition but there are so many treatments which can be helpful, and some are cured. There are two types of acute lymphocytic leukemia. First, B-cell acute lymphocytic leukemia which affects the B-cells that make antibodies and fight infection. Second, T-cell acute lymphocytic leukemia which affects T-cells that kill germs and support other immune cells.
What Is Chemotherapy?
Chemotherapy, which is also known as chemo, is the main and important treatment for people who are suffering from acute lymphocytic leukemia (ALL). The drugs travel from the bloodstream and they reach the cancer cells all over your body. It makes the chemo useful for cancers like leukemia which is spread all over your body. Chemotherapy is infused into the bloodstream through an IV and some patients receive it as pills or as an injection.
Phases of Chemotherapy for ALL (Acute Lymphocytic Leukemia)
The treatment of chemotherapy for ALL depends on the type of ALL, health and age. Chemotherapy is given in cycles, and every period of treatment requires a time of rest so that your body gets the time to recover from that. But mainly it is divided into 3 phases.
Induction
Induction is also known as remission induction. It is usually short and intense. It stays for about approx 2 months. The purpose of this phase is to destroy as many leukemia cells as possible. When we start our treatment after the diagnosis, the doctor gives chemotherapy drugs for several weeks. It damages the healthy bone marrow cells and leukemia cells. Chemotherapy for acute lymphocytic leukemia involves inserting the drugs into the body by injection into the muscle or skin. It can also be injected by the mouth or vein, which we call oral chemotherapy and IV chemotherapy.
Those drugs enter your body through this and get mixed in your blood. It reaches the leukemia cells and your whole body. So, you have to stay in the hospital till your blood cells recover properly but it depends on the protocol. In this, you need blood or platelet transfusions because your blood cell count is low for some weeks. The blood cell count tells that how many red blood cells, white blood cells, and platelets you have. There are some of the drugs like:
- Asparaginase
- Asparaginase
- Cyclophosphamide
- Cytarabine
- Doxorubicin or Daunorubicin
- Idarubicin
- Methotrexate
- Mercaptopurine
- Vincristine
Sometimes you have given the combination of chemotherapy drugs for a few weeks which we call a chemotherapy regimen.
Chemotherapy into the Fluid around the Spinal Cord and Brain
Leukemia cells can sometimes travel to the brain and spinal cord, the center of the nervous system or CNS. For the induction treatment, your doctor injects the chemotherapy into the fluid that flows around the spinal cord and brain. We call this procedure intrathecal chemotherapy. The intrathecal chemotherapy helps to prevent the leukemia cells from spreading to the CNS. You can have intrathecal chemotherapy in all phases of your treatment. There are many chemotherapy drugs which make it difficult to reach the brain and spinal cord. In this, you may need the injection into your cerebrospinal fluid. It helps to kill the cancer cells in that area. You can also have this injection if:
- Leukemia cells are found in the CNS during the diagnosis.
- There is a high chance of developing leukemia cells in the body.
Steroids alongside Chemotherapy
Steroids are made by our body naturally in small amounts which help to control some of the functions. But it can also be made artificially and used to treat ALL. There is also the type of steroid, corticosteroids. These are made by man versions of hormones produced by the adrenal glands which are just above the kidneys. Corticosteroids have:
- Dexamethasone
- Hydrocortisone
- Methylprednisolone
- Prednisolone
The doctor started to give the steroids for a week before the chemotherapy for induction treatment. Steroids may be a good option for getting rid of the leukemia cells. It is also beneficial for the doctor and you because it gives time to start the chemotherapy for a better result of the important genetic test.
Immunotherapy and Targeted Cancer Drugs alongside Chemotherapy
It is a type of drug which we call monoclonal antibodies, that helps to kill the leukemia cells and find those proteins. If you have a Philadelphia-positive ALL, then you can target the cancer drug with a tyrosine kinase inhibitor with the chemotherapy treatment. This is a tablet which you have to take every day till you complete all phases of the treatment. There is also an immunotherapy which is known as CAR T-cell therapy. If you are suffering from B-cell ALL and you can no longer treat it, then you can go with that.
Consolidation
We also call consolidation intensification. It is also intensive. This stays for around 6 months. After the treatment of induction, you have a test of bone marrow biopsy. A pathologist takes a look at the biopsy to identify if there is any risk or sign of leukemia in your bone marrow. And if there is no sign of this and your blood count level is normal then we call it complete remission, CR. The main motive of this phase is to get rid of leukemia cells. It also helps to reduce the risk of getting leukemia again.
In this, you have to be hospitalized for a week every month. In this phase, you will get some of the same drugs as in the induction phase and some other drugs. Usually, you will have higher doses of drugs so that the treatment is stronger. So, the drugs for this phase are:
- Asparaginase
- Cyclophosphamide
- Cytarabine
- Daunorubicin
- Daunorubicin
- Doxorubicin
- Etoposide
- Methotrexate
- Mercaptopurine
- Vincristine
You had the combination of these drugs with some of the induction phase drugs.
Chemotherapy before a Stem Cell or Bone Marrow Transplant
Some people have a transplant of stem cells using another person’s cells which is called an allogeneic transplant. You have to do chemotherapy before the transplant so that your body gets prepared for the stem cells. It is also known as conditioning treatment and has two types: full intensity conditioning, also called myeloablatives and reduced intensity conditioning which is known as RIC.
The full intensity conditioning has a very high level of doses for chemotherapy. And the reduced intensity conditioning has a lower level of doses for the chemotherapy. This treatment kills the leukemia cells and healthy cells which are in the bone marrow. So this process makes some space in the bone marrow for the bone marrow transplant. It weakens your immune system so that you can’t reject the donor cells.
Maintenance
We call post consolidation to the maintenance too. It is less intensive. It usually lasts for around 2 to 3 years. The maintenance treatment motive is to prevent relapse. You still had chemotherapy, but the doses are at a low amount compared to the previous phases. The chemotherapy drugs that you have during the maintenance are:
- Dexamethasone
- Methotrexate
- Mercaptopurine
- Prednisolone (steroids)
- Vincristine
This treatment is usually involved oral anticancer drugs and a patient gets their treatment without staying at the hospital. They just visit the hospitals for the treatment and for doses and come back home after the check-up. During this phase, some people can go to work, college and do their daily activities.
Common Drugs of Chemotherapy for Acute Lymphocytic Leukemia
Chemotherapy for acute lymphocytic leukemia is used in combination with anticancer drugs. The commonly used drugs of chemotherapy are:
- Vincristine
- Cytarabine
- Methotrexate
- Cyclophosphamide
- Prednisone
- Dexamethasone
During the treatment, people get some of the drugs which is mentioned above at different times. But people don’t get all the drugs.
Side Effects of Chemotherapy
The drugs can affect some normal cells, which leads to side effects in your body. It depends on which type of drugs are taken and how long the doses are taken. So, the common side effects of chemotherapy are:
- Hair loss
- Mouth sores
- Nausea and vomiting
- Diarrhea or constipation
- Risk of infection
- Breathlessness and looking pale
- Bruising
- Bleeding gums or nosebleeds
- Feeling sick
- Tiredness and weakness
There are some ways by which you can reduce the side effects. For example, you can have medicines to reduce nausea and vomiting. But before taking anything, you should ask your cancer doctor. Tell them about the side effects you are facing so they can manage them.
When to have Chemotherapy for Acute Lymphocytic Leukemia?
Chemotherapy is the main treatment for acute lymphocytic leukemia. If you are feeling the symptoms or signs in your body, then you need to do some blood tests as per the doctor’s suggestion. The symptoms are:
- Bleeding ( like from the gums, nosebleeds, or heavy menstrual periods)
- Bruising
- Bone pain
- Cranial nerve palsies
- Enlarged liver
- Enlarged spleen
- Fatigue
- Fever
- Frequent infections
- Joint pain
- Night sweats
- Nosebleeds
- Paleness
- Shortness of breath
If you are suffering from these symptoms, then you should consult a doctor. Sometimes it can be the flu because it also has the same symptoms, but you should check before.
Conclusion
Chemotherapy is a treatment that treats cancer and its type. We have explained how to treat and control acute lymphocytic leukemia. Chemotherapy for acute lymphocytic leukemia has phases to heal it properly. It provides drugs to treat the cancer as soon as possible. But there are some side effects of this too, like vomiting, loss of appetite, hair loss, etc.
Note: This blog is only for informational purposes. So before taking any medicines, you should consult the doctor.
