Skip to main content

Acute lymphocytic leukemia (ALL) is also named acute lymphoblastic leukemia, which is the most common hematologic malignancy cancer of bone marrow. It is typically featured by the overproduction of immature lymphoblasts. 

Acute lymphocytic leukemia (ALL) is a biologically heterogeneous disorder, so that the morphologic, immunologic, biochemical, cytogenetic, and molecular genetic characterizations of leukemic lymphoblasts are required to establish the diagnosis or to exclude other probable causes of bone marrow failure and, finally, to classify ALL subtypes. This heterogeneity demonstrates the actuality that leukaemia may establish at any point while on the several stages of normal lymphoid differentiation.

It has been reported that approximately 6000 patients are diagnosed with this condition annually, and it accounts for more than 75% of acute leukemias in children, and 20% of all leukemias in adults.

Chemotherapy (chemo) is the consideration of drugs to treat cancer. Chemo drugs are known to travel through the bloodstream to reach malignant cells all over the body. This makes chemotherapy useful for diseases such as leukemia that has spread throughout the body.

Chemotherapy is the main treatment for just about all individuals with acute lymphocytic leukemia (ALL). Due to its potential side effects, chemotherapy might not be recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy.

How is chemotherapy given: Chemotherapy treatment for Acute Lymphocytic Leukemia is typically divided into 3 phases:

  • Induction: It is short and intensive, typically lasts about a month.
  • Consolidation (intensification): It is also intensive, typically lasting for a few months.
  • Maintenance (post-consolidation): It is less intensive, typically lasts for about a couple of years.

During a bit more intensive phases of treatment, individuals can often have severe side effects from chemotherapy, so they might need to spend some time in the hospital. 

Chemotherapy is typically given in cycles, with each period of treatment followed by a rest period to enable the body time to recover. Most often, chemotherapy drugs are injected into a vein (IV), into a muscle, or under the skin, or are taken orally. These drugs reach into the blood and can reach leukemia cells all over the body.

Most chemotherapy drugs have trouble reaching the portion around the brain and spinal cord, so the chemotherapy may need to be injected into the cerebrospinal fluid (CSF) to destroy malignant cells in that portion. This is named intrathecal chemotherapy. Intrathecal chemotherapy can be given during a spinal tap or by using a special catheter known as an Ommaya reservoir.

Chemotherapy Drugs Used to Treat ALL

Chemotherapy for acute lymphocytic leukemia uses a combination of anti-cancer medicines. The most commonly used chemotherapy drugs for leukemia (ALL) include:

Vincristine Liposomal: Vincristine liposomal specifically is a new form of a chemotherapy medicine named vincristine that may be a bit more effective and a bit less toxic than current chemotherapy drugs because it is encapsulated in a protective shell. It is administered straight into the bloodstream via a drip. Certain studies have suggested vincristine liposomal may be helpful for individuals whose first 2-treatments have already failed and their leukaemia has returned. It may also cause fewer adverse reactions than the current form of vincristine.

This widely used chemotherapeutic agent should only be administered intravenously, and never by any other route. Many patients receiving vincristine injection (intravenous) also take other medicine via a spinal route as part of their treatment protocol. 
Nelarabine: Nelarabine specifically is a purine nucleoside analog and antineoplastic agent approved to treat patients with acute T-cell lymphoblastic leukemia and T-cell lymphoblastic lymphoma with inadequate clinical response to earlier chemotherapeutic treatments.
Addition of the nelarabine injection (Arranon) to standard chemotherapy helps improve the survival for children and newly diagnosed young adult patients with T-cell acute lymphoblastic leukemia (T-ALL). 
Doxorubicin (Adriamycin): Doxorubicin is an antibiotic and also known as Adriamycin. It is derived from the Streptomyces peucetius bacterium. It has widespread use as a chemotherapeutic agent since the year of 1960s. It is a part of the anthracycline group of chemotherapeutic agents. Apart from treating acute myeloblastic leukemia, Doxorubicin may also be used to treat acute lymphoblastic leukemia, Hodgkin lymphoma, small cell lung cancer, soft tissue and bone sarcomas and cancers of the bladder, breast, ovary, and thyroid. 
Doxorubicin injection is administered intravenously and is generally given in 21-day intervals. The medicine is easily recognizable in its liquid form because of its highly pigmented, reddish appearance. This medicinal product is incompatible with fluorouracil and heparin and can be responsible for causing precipitation in mixed with these medicines. While doxorubicin may be administered rapidly (over 15 to 20 minutes), slow administration of the liposomal formulation is needed to reduce the risk of infusion reactions. Doxorubicin medication should be stored in a refrigerated area and re from light prior to the administration.
Cytarabine (Ara-C): Cytarabine or Ara-C is a drug used to treat acute lymphoblastic leukemia. It is also used with other medicines to treat adults and children with acute myeloid leukemia and for the prevention and treatment of a type of leukemia that has spread to the meninges (the tissue that covers and protects the brain as well as spinal cord). Cytarabine injection may also be used for treating blastic phase chronic myelogenous leukemia.
This medicinal product is also being studied for treating a few other sorts of cancer. Cytarabine or Ara-C inhibits cells from making DNA and may destroy malignant cells. This medicine is a type of antimetabolite. 
Pegaspargase : Oncaspar  is introduced as a component of a multi-agent chemotherapeutic regimen for treating pediatric and adult patients with:
  • First-line acute lymphoblastic leukemia (ALL)
  • Acute lymphoblastic leukemia and hypersensitivity to native forms of L-asparaginase
Pegaspargase has been helping patients fight acute lymphoblastic leukemia for 25 years and counting. Patients receiving pegaspargase injection may experience adverse reactions, which may fluctuate from person to person. 
 Methotrexate: Methotrexate is FDA approved medicine, used alone or with other medicinal products for treating individuals who have acute lymphoblastic leukemia (ALL) that has reached to the central nervous system (CNS) or to prevent acute lymphoblastic leukemia from spreading to the CNS. This medication is also FDA approved for the treatment of individuals who have advanced non-Hodgkin lymphoma and advanced mycosis fungoides. It may also be prescribed for the treatment of individuals with other types of blood cancer.
Cyclophosphamide: Cyclophosphamide is FDA approved agent to treat acute and chronic lymphocytic leukemia. It is also used to treat several other cancers, including people who have acute and chronic myeloid leukemia, myeloma, Hodgkin lymphoma, non-Hodgkin lymphoma and mycosis fungoides. Cyclophosphamide is usually recommended in combination with other medicines.
The cyclophosphamide may be responsible for causing a temporary loss of hair in some individuals. After therapy has ended, normal hair growth should return, although the fresh hair may be a slightly different color or texture.
Prednisone: Prednisone specifically is a corticosteroid that has a broad range of activities. In acute myeloid leukemia, this agent is recommended because of its direct antileukemic effects. Prednisone is introduced to be used for reducing inflammation and suppressing (lower) the body’s immune response.
Apart from ALL, Prednisone is used with other medicines to treat acute myeloid leukemia (AML). It is prescribed as palliative therapy in adults and children.

Dexamethasone: It is another corticosteroid that acts as an crucial chemotherapeutic agent in treating ALL. Like prednisone, this medicinal product is used in induction and reinduction therapy and is also given as intermittent pulses while on continuation therapy.

Individuals typically get several of these medications at different times throughout the course of treatment, but they do not get all of them.
 Possible Side Effects of Chemotherapy
Chemotherapy agents can affect some normal cells in the body, which can be responsible for certain side effects. The side effects of chemotherapy depend on the type and dose of medicines given and the time-span they are taken. Common side effects due to chemo can include:
  • Hair loss
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Mouth sores
  • Loss of appetite
Chemotherapy medicines also affect the normal cells in bone marrow, which can reduce blood cell counts. This can lead to:
  • Increased probability of infections (from having too few normal WBCs)
  • Bleeding bruising (from having decreased blood platelets)
  • Fatigue and shortness of breath (from having too few RBCs)
Adverse Reactions of Specific Drugs: Certain medicines might cause specific adverse reactions. For instance:
  • Cytarabine (Ara-C), mainly when used at high doses, can cause dryness in the eyes and can affect certain parts of the brain, which can lead to complications with coordination and balance.
  • Vincristine can be responsible for damaging the nerves, which can lead to numbness, tingling, or weakness in hands or feet.
  • Anthracyclines (such as daunorubicin or doxorubicin) can be responsible for damaging the heart, so the total dose requires to be watched closely, and these drugs might not be given to someone who already has heart complications.
Nitin Goswami

Nitin Goswami joined us as an Editor in 2020. He covers all the updates in the field of Pharmaceutical, Business Healthcare, Health News, Medical News, and Pharma News.

Leave a Reply

Close Menu