There are many treatment choices for acute lymphocytic leukemia (ALL). Which one may work best for you? It depends on a number of factors, such as:

• Your age
• Your overall health
• Functional status
• Your subtype of ALL
• Results of your lab tests (such as your white blood cell count at diagnosis)
• If the leukemia cells have certain gene or chromosome changes
• If the leukemia is affecting your brain and spinal cord, spleen, or liver
• Your personal needs and preferences
• How well the leukemia responds to the first treatment (induction)

You may have questions and concerns about your treatment choices. You may want to know how you'll feel and function after treatment, and if you'll have to change your normal activities.

Your doctor is the best person to answer your questions. They can tell you what your treatment choices are, how well they're expected to work, and what the risks and side effects are. Your doctor may suggest a certain treatment. Or you might be offered more than one and asked to decide which one you'd like to use. It can be hard to make this decision. While it's important to take the time you need to make the best decision for you, ALL treatment tends to be started very soon after diagnosis.

Chemotherapy (chemo) is the main way to treat ALL. The treatment uses strong medicines to kill cancer cells. There are many types of chemo used to treat ALL. More than one are often given. The chemo medicines are put into your blood. The goal is to kill the ALL cells quickly and put the cancer into remission. Remission means there are no signs of cancer in your body. Chemo may also be put right into your cerebrospinal fluid (CSF) to prevent cancer growth or to kill cancer cells around your brain and nervous system. This is called intrathecal chemotherapy. It's also called central nervous system (CNS) prophylaxis.

This type of treatment uses high-energy X-rays to kill cancer cells. It's not part of the main treatment for ALL. But it may be used to kill or prevent the spread of cancer in your central nervous system (brain and spine). It may be used as part of a stem cell transplant. In rare cases, it may be done to shrink a tumor that's affecting a certain part of your body.

If the normal doses of chemotherapy don't work, you may need very high doses of chemo. These high doses can damage the stem cells in your bone marrow. Blood stem cells are the "starter" cells for new blood cells. Sometimes, high-dose chemotherapy is used to kill all your stem cells. Then you're given stem cells from a volunteer donor. Over time, they go into your bone marrow and restore your body's ability to make blood cells. This is called an allogeneic stem cell transplant.

These medicines target certain abnormal proteins on ALL cells, such as those caused by the Philadelphia chromosome. These medicines can be helpful if your ALL cells have this mutation. They're taken daily as pills.

Immunotherapy

This type of drug therapy helps your immune system destroy cancer cells by better identifying them. It may be given alone or with other treatment types. Immunotherapy includes antibody therapy and CAR-T therapy.

Researchers are always finding new and better ways to treat ALL. These new methods are tested in clinical trials. Talk with your doctor to find out if there are any clinical trials you should consider.

At first, thinking about treatment choices may seem overwhelming. Talk with your doctors, nurses, and loved ones. Make a list of questions. Consider the benefits and possible side effects of each choice. Discuss your concerns with your doctors before making a decision.