Treating Acute Lymphocytic Leukemia (ALL)

Acute leukemias grow very quickly, they try to kill you very quickly, and they require aggressive treatment to try to get you into remission and keep you there.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

Acute lymphocytic leukemia is a cancer of the blood and bone marrow. Without treatment, ALL spreads through your bloodstream. It often advances rapidly. It may spread to your central nervous system (brain and spinal cord).

It’s necessary to begin treatment as soon as possible after diagnosis.

At Scott & White, we explore every treatment option. In many cases, your leukemia treatment will include a combination of approaches.Treatment options for ALL include:

  • Chemotherapy
  • Allogeneic Blood Stem-Cell Transplant
  • Targeted Therapy
  • Radiation Therapy

Your physician will discuss which treatment options are best for you.

At Scott & White, treatment goals for leukemia generally are centered on inducing remission.


Chemotherapy is the primary method of treating ALL. Chemotherapy is a form of cancer treatment where high-powered drugs are given to stop the leukemic cells from multiplying. The goal of chemotherapy is remission.

We think of it as initial-induction chemotherapy. This is where we take someone who’s acutely ill, and we treat them with chemotherapy to induce a remission, so induction therapy. The goal is to try to get it to where we can’t see those cells in the bone marrow anymore and they’re back to making blood normally.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

Two Phases of ALL Chemotherapy

Chemotherapy for ALL has a two-pronged approach: Induction therapy followed by consolidation therapy.

Induction Therapy

  • Very intensive, high-dose chemotherapy
  • Tries to destroy as many ALL cells as possible
  • Attempts to return your blood cell counts to normal
  • Generally requires a 4-week stay in the hospital with a week’s worth of chemotherapy

Goals of Induction Therapy:

  • Remission of your ALL
  • Stop ALL symptoms
  • Percentage of blast (leukemic) cells in bone marrow is less than 5 percent
  • No abnormal cells in:
    • Blood
    • Bone marrow
    • Cerebrospinal fluid (CSF)

Induction therapy often has significant side effects:

  • Very low blood counts, especially your white counts, so that you'll need blood transfusions
  • Multiple infections requiring antibiotic treatment

If your induction therapy is effective, you should begin making your own bone marrow after about 3 weeks. Your bone marrow screen should show no leukemic cells after the 4-week mark.

At this point, you should have:

  • Normal blood counts
  • No infections
  • No need for transfusions

However, your ALL is likely to return. The next step is to begin consolidation therapy, a rigorous treatment designed to destroy any remaining leukemic cells that are too small for testing to find.

Consolidation Therapy

  • Very intensive, high-dose chemotherapy
  • Begins when you’re in remission
  • Attempts to destroy any remaining ALL cells present in your bone marrow not detected by testing
  • Generally requires a 4-week stay in the hospital with a week’s worth of chemotherapy

Without consolidation therapy, your ALL is likely to return.

The idea of consolidation therapy is to apply more treatment during that phase to sort of kick it while it’s down and try to ensure and maintain a remission that we’ve already achieved.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

In some cases, your physician may recommend an allogeneic blood stem-cell transplant rather than consolidation therapy.

Intrathecal Therapy

If your physician team suspects ALL cells may collect in the lining of your brain or spinal canal, they may recommend intrathecal therapy for your ALL. In this treatment approach, chemotherapy drugs are administered directly into your spinal canal via lumbar puncture.

Find out more about chemotherapy for your leukemia

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Allogeneic Blood Stem-Cell Transplant

In some cases, your physician may suggest you consider receiving blood stem-cell transplant.

Blood stem-cell transplant is a procedure replacing your leukemic bone marrow with healthy bone marrow stem cells. An allogeneic transplant (ALLO) involves removing bone marrow from a matched donor. (Allo means “other.”)

Scott & White does not offer allogeneic blood stem-cell transplants. All allogeneic blood stem-cell transplants are referred to one of our accredited partners in the state.

Find out more about allogeneic blood stem-cell transplant for leukemia

Targeted Therapy

In some cases, depending on the subtype of ALL you have, your physician team may recommend one or more several federally approved targeted therapies for your ALL.

Find out more about targeted therapies

Radiation Therapy

Radiation therapy uses high-powered X-rays, seeds or radioactive material to shrink or destroy your tumor.

Radiation therapy is infrequently used to treat leukemia. However, in some cases, your physician team may recommend concurrent radiation therapy in addition to other treatments for your leukemia.

Find out about radiation therapy for your leukemia

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