Acute lymphoblastic leukaemia (ALL) treatment types and side effects
Acute lymphoblastic leukaemia (ALL) relapse
As many as nine out of ten adults with ALL (90%) will go into remission (although this doesn’t necessarily mean that they’re cured).
Unfortunately, some people relapse (the ALL comes back). Relapse happens because some leukaemia cells remain, often because they’ve become resistant to the drugs people are being treated with. If you do relapse you may be offered the opportunity to go on another clinical trial looking at new treatments for relapsed ALL.
Usually, the first step in treating relapsed ALL is to repeat the remission induction programme. This treatment might need to be more intense than the first time around. In trials, a second go at remission induction using chemotherapy has worked for around four out of ten people (40%).
There are two new drugs called blinatumomab and inotuzumab which have recently become available on the NHS for relapsed ALL. These drugs are known as monoclonal antibodies − they work by attaching themselves to the leukaemia cells, so your immune system can find these cells and kill them. They have shown promising results in clinical trials and tend to have fewer unpleasant side effects.
If your treatment is successful this time round and you go into remission (CR), your healthcare team may recommend a stem cell transplant.
Some people may decide not to have active treatment any more. Instead they can ask for palliative care, which focuses on relieving their cancer symptoms and improving their quality of life.
Treatment for relapsed Philadelphia positive ALL
If you have Philadelphia positive ALL and you relapse after chemotherapy with imatinib (or it doesn’t put you in remission in the first place), your healthcare team may offer you more chemotherapy with a different TKI (tyrosine kinase inhibitor). Dasatinib is a TKI that can be used for people who have relapsed or not responded to treatment including imatinib. Ponatinib is another option that doctors can recommend.
Information for young adults
For young adults with leukaemia, lymphoma or any blood cancer type. Your guide to treatment, side effects, coping with emotions, friends and work or study.
Potential future treatment
There is also a new treatment called CAR-T therapy, which is currently being trialled for some people with relapsed ALL. T cells (a type of white blood cell) are removed from the body and altered in a lab to make them more effective at killing leukaemia cells. They are then put back into the body.
CAR-T therapy could offer people with hard-to-treat ALL another treatment option.
See our blog for more information on CAR-T therapy.
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