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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65844_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65844_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65844_"><span class="title" itemprop="name">Adult Acute Lymphoblastic Leukemia Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: September 17, 2015.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000257989__197">This PDQ cancer information summary has current information about the treatment of acute lymphoblastic leukemia. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000257989__198">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000257989__1"><h2 id="_CDR0000257989__1_">General Information About Adult Acute Lymphoblastic Leukemia</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000257989__2">Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which
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the bone
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marrow makes too many lymphocytes (a type of white blood cell).</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__184">Leukemia may affect red blood cells, white blood cells, and platelets.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__12">Previous chemotherapy and exposure to radiation may increase the risk of developing ALL.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__177">Signs and symptoms of adult ALL include fever, feeling tired, and easy bruising or bleeding. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__17">Tests that examine the blood and bone marrow are
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used to detect (find) and diagnose adult ALL.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__21">Certain factors affect prognosis (chance
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of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000257989__2"><h3>Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which
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the bone
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marrow makes too many lymphocytes (a type of white blood cell).</h3><p id="CDR0000257989__4">Adult <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (ALL; also called acute lymphocytic
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leukemia) is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>. This type of cancer usually gets worse quickly if it is not treated.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000257989194" co-legend-rid="figlgndCDR0000257989194"><a href="/books/NBK65844.2/figure/CDR0000257989__194/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000257989194" rid-ob="figobCDR0000257989194"><img class="small-thumb" src="/books/NBK65844.2/bin/CDR0000755927.gif" src-large="/books/NBK65844.2/bin/CDR0000755927.jpg" alt="Anatomy of the bone" /></a><div class="icnblk_cntnt" id="figlgndCDR0000257989194"><h4 id="CDR0000257989__194"><a href="/books/NBK65844.2/figure/CDR0000257989__194/?report=objectonly" target="object" rid-ob="figobCDR0000257989194">Figure</a></h4><p class="float-caption no_bottom_margin">Anatomy of the bone. The bone is made up of compact bone, spongy bone, and bone marrow. Compact bone makes up the outer layer of the bone. Spongy bone is found mostly at the ends of bones and contains red marrow. Bone marrow is found in the center of <a href="/books/NBK65844.2/figure/CDR0000257989__194/?report=objectonly" target="object" rid-ob="figobCDR0000257989194">(more...)</a></p></div></div></div><div id="CDR0000257989__184"><h3>Leukemia may affect red blood cells, white blood cells, and platelets.</h3><p id="CDR0000257989__186">Normally,
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the bone marrow makes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000765906/" class="def">blood stem cells</a> (immature <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>) that become mature blood cells over time. A blood stem cell may become a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046279/" class="def">myeloid</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cell</a> or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046298/" class="def">lymphoid</a> stem cell.</p><p id="CDR0000257989__187">A myeloid stem cell becomes one of three types of mature blood cells: </p><ul id="CDR0000257989__188"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">Red blood cells</a> that carry <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a> and other substances to all
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> of the body.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">Platelets</a> that form <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476017/" class="def">blood clots</a> to stop bleeding.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046374/" class="def">Granulocytes</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a>) that fight <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> and disease. </div></li></ul><p id="CDR0000257989__189">A lymphoid stem cell becomes a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302475/" class="def">lymphoblast</a> cell and then one of three types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045765/" class="def">lymphocytes</a> (white blood cells):</p><ul id="CDR0000257989__190"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044953/" class="def">B lymphocytes</a> that make <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to help fight infection.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T lymphocytes</a> that help B lymphocytes make the antibodies that help fight infection.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044062/" class="def">Natural killer cells</a> that attack cancer cells and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045941/" class="def">viruses</a>.</div></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000257989149" co-legend-rid="figlgndCDR0000257989149"><a href="/books/NBK65844.2/figure/CDR0000257989__149/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000257989149" rid-ob="figobCDR0000257989149"><img class="small-thumb" src="/books/NBK65844.2/bin/CDR0000526538.gif" src-large="/books/NBK65844.2/bin/CDR0000526538.jpg" alt="Blood cell development" /></a><div class="icnblk_cntnt" id="figlgndCDR0000257989149"><h4 id="CDR0000257989__149"><a href="/books/NBK65844.2/figure/CDR0000257989__149/?report=objectonly" target="object" rid-ob="figobCDR0000257989149">Figure</a></h4><p class="float-caption no_bottom_margin">Blood cell development. A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell. </p></div></div><p id="CDR0000257989__191">In ALL, too many stem cells become lymphoblasts, B lymphocytes, or T lymphocytes. These cells are also called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> cells. These leukemia cells are not able to fight infection very well. Also, as the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may cause infection, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045360/" class="def">anemia</a>, and easy bleeding. The cancer can also spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">central nervous system</a> (brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal
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cord</a>). </p><p id="CDR0000257989__192"> This summary is about adult acute lymphoblastic leukemia.
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See the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summaries for information about other types of leukemia: </p><ul id="CDR0000257989__193"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258001/">Childhood Acute Lymphoblastic Leukemia Treatment</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000257990/">Adult Acute Myeloid Leukemia Treatment</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258000/">Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258005/">Chronic Lymphocytic Leukemia Treatment</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258006/">Chronic Myelogenous Leukemia Treatment</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258013/">Hairy Cell Leukemia Treatment</a>.</div></li></ul></div><div id="CDR0000257989__12"><h3>Previous chemotherapy and exposure to radiation may increase the risk of developing ALL.</h3><p id="CDR0000257989__100">Anything that increases your risk of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Possible risk factors for ALL include the following:</p><ul id="CDR0000257989__101"><li class="half_rhythm"><div>Being male.</div></li><li class="half_rhythm"><div>Being white.</div></li><li class="half_rhythm"><div>Being older than 70.</div></li><li class="half_rhythm"><div>Past treatment with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li><li class="half_rhythm"><div>Being exposed to high levels of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> in the environment (such as nuclear radiation).</div></li><li class="half_rhythm"><div>Having certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046391/" class="def">genetic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407758/" class="def">disorders</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045488/" class="def">Down syndrome</a>.</div></li></ul></div><div id="CDR0000257989__177"><h3>Signs and symptoms of adult ALL include fever, feeling tired, and easy bruising or bleeding. </h3><p id="CDR0000257989__178">The early <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> of ALL may be like the flu or other common diseases.
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Check with your doctor if you have any of the following:</p><ul id="CDR0000257989__122"><li class="half_rhythm"><div>Weakness or feeling tired.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a> or night sweats.</div></li><li class="half_rhythm"><div>Easy bruising or bleeding.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046236/" class="def">Petechiae</a> (flat, pinpoint spots under the skin, caused by bleeding).</div></li><li class="half_rhythm"><div>Shortness of breath.</div></li><li class="half_rhythm"><div>Weight loss or loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a>.</div></li><li class="half_rhythm"><div>Pain in the bones or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>.</div></li><li class="half_rhythm"><div>Pain or feeling of fullness below the ribs.</div></li><li class="half_rhythm"><div>Painless lumps in the neck, underarm, stomach, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>.</div></li><li class="half_rhythm"><div>Having many <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infections</a>.</div></li></ul><p id="CDR0000257989__16">These and other signs and symptoms may be caused by adult acute lymphoblastic
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leukemia or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>.</p></div><div id="CDR0000257989__17"><h3>Tests that examine the blood and bone marrow are
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used to detect (find) and diagnose adult ALL.</h3><p id="CDR0000257989__19">The following tests and procedures may be used:
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</p><ul id="CDR0000257989__20"><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045669/" class="def">disease</a>, such as infection or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000729979/" class="def">Complete blood
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count (CBC) with differential</a></b>: A procedure in which a sample of blood is drawn and
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checked for the following:
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<ul id="CDR0000257989__80"><li class="half_rhythm"><div>
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The number of red blood cells and platelets.</div></li><li class="half_rhythm"><div>The number and type of white blood cells.</div></li><li class="half_rhythm"><div>The amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045108/" class="def">hemoglobin</a> (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> that carries oxygen) in the red blood cells.</div></li><li class="half_rhythm"><div>The portion of the blood sample made up of red blood cells.
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</div></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000257989136" co-legend-rid="figlgndCDR0000257989136"><a href="/books/NBK65844.2/figure/CDR0000257989__136/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000257989136" rid-ob="figobCDR0000257989136"><img class="small-thumb" src="/books/NBK65844.2/bin/CDR0000526546.gif" src-large="/books/NBK65844.2/bin/CDR0000526546.jpg" alt="Complete blood count (CBC)" /></a><div class="icnblk_cntnt" id="figlgndCDR0000257989136"><h4 id="CDR0000257989__136"><a href="/books/NBK65844.2/figure/CDR0000257989__136/?report=objectonly" target="object" rid-ob="figobCDR0000257989136">Figure</a></h4><p class="float-caption no_bottom_margin">Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used <a href="/books/NBK65844.2/figure/CDR0000257989__136/?report=objectonly" target="object" rid-ob="figobCDR0000257989136">(more...)</a></p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry studies</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390307/" class="def">Peripheral blood smear</a></b>: A procedure in which a sample of blood is checked for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046503/" class="def">blast</a> cells, the number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046505/" class="def">Bone marrow aspiration</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046506/" class="def">biopsy</a></b>: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000549425/" class="def">breastbone.</a> A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the bone marrow, blood, and bone under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> cells.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000257989179" co-legend-rid="figlgndCDR0000257989179"><a href="/books/NBK65844.2/figure/CDR0000257989__179/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000257989179" rid-ob="figobCDR0000257989179"><img class="small-thumb" src="/books/NBK65844.2/bin/CDR0000554337.gif" src-large="/books/NBK65844.2/bin/CDR0000554337.jpg" alt="Bone marrow aspiration and biopsy" /></a><div class="icnblk_cntnt" id="figlgndCDR0000257989179"><h4 id="CDR0000257989__179"><a href="/books/NBK65844.2/figure/CDR0000257989__179/?report=objectonly" target="object" rid-ob="figobCDR0000257989179">Figure</a></h4><p class="float-caption no_bottom_margin">Bone marrow aspiration and biopsy. After a small area of skin is numbed, a bone marrow needle is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope. </p></div></div></div><div class="half_rhythm">The following tests may be done on the samples of blood or bone marrow tissue that are removed:<ul id="CDR0000257989__173"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270737/" class="def">Cytogenetic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390238/" class="def">analysis:</a></b> A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are certain changes in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosomes</a> in the lymphocytes. For example, sometimes in ALL, part of one chromosome is moved to another chromosome. This is called the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044179/" class="def">Philadelphia chromosome</a>. Other tests, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000460151/" class="def">fluorescence in situ hybridization</a> (FISH), may also be done to look for certain changes in the chromosomes. <div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000257989180" co-legend-rid="figlgndCDR0000257989180"><a href="/books/NBK65844.2/figure/CDR0000257989__180/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000257989180" rid-ob="figobCDR0000257989180"><img class="small-thumb" src="/books/NBK65844.2/bin/CDR0000533336.gif" src-large="/books/NBK65844.2/bin/CDR0000533336.jpg" alt="Philadelphia chromosome" /></a><div class="icnblk_cntnt" id="figlgndCDR0000257989180"><h4 id="CDR0000257989__180"><a href="/books/NBK65844.2/figure/CDR0000257989__180/?report=objectonly" target="object" rid-ob="figobCDR0000257989180">Figure</a></h4><p class="float-caption no_bottom_margin">Philadelphia chromosome. A piece of chromosome 9 and a piece of chromosome 22 break off and trade places. The bcr-abl gene is formed on chromosome 22 where the piece of chromosome 9 attaches. The changed chromosome 22 is called the Philadelphia chromosome. <a href="/books/NBK65844.2/figure/CDR0000257989__180/?report=objectonly" target="object" rid-ob="figobCDR0000257989180">(more...)</a></p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000341450/" class="def">Immunophenotyping</a></b>: A process used to identify cells, based on the types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">markers</a> on the surface of the cell. This process is used to diagnose the subtype of ALL by comparing the cancer cells to normal cells of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>. For example, a cytochemistry study may test the cells in a sample of tissue using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643008/" class="def">chemicals</a> (dyes) to look for certain changes in the sample. A chemical may cause a color change in one type of leukemia cell but not in another type of leukemia cell.</div></li></ul></div></li></ul></div><div id="CDR0000257989__21"><h3>Certain factors affect prognosis (chance
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of recovery) and treatment options.</h3><p id="CDR0000257989__102">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) and treatment options depend on the following:</p><ul id="CDR0000257989__103"><li class="half_rhythm"><div>The age of the patient.</div></li><li class="half_rhythm"><div>Whether the cancer has spread to the brain or spinal cord.</div></li><li class="half_rhythm"><div>Whether there are certain changes in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a>, including the Philadelphia chromosome.</div></li><li class="half_rhythm"><div>Whether the cancer has been treated before or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back).</div></li></ul></div></div><div id="CDR0000257989__123"><h2 id="_CDR0000257989__123_">Stages of Adult Acute Lymphoblastic Leukemia</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000257989__124">Once adult ALL has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system (brain and spinal cord) or to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__127">There is no standard staging system for adult ALL.</a></div></li></ul></div><div id="CDR0000257989__124"><h3>Once adult ALL has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system (brain and spinal cord) or to other parts of the body.</h3><p id="CDR0000257989__126">The extent or spread of cancer is usually described as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stages</a>. It is important to know whether the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> has spread outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> in order to plan treatment. The following tests and procedures may be used to determine if the leukemia has spread: </p><ul id="CDR0000257989__106"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">Chest x-ray</a></b>: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046303/" class="def">Lumbar puncture</a></b>: A procedure used to collect a sample of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (CSF) from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000396787/" class="def">spinal column</a>. This is done by placing a needle between two bones in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a> and into the CSF around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a> and removing a sample of the fluid. The sample of CSF is checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> for signs that leukemia <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> have spread to the brain and spinal cord. This procedure is also called an LP or spinal tap.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000257989151" co-legend-rid="figlgndCDR0000257989151"><a href="/books/NBK65844.2/figure/CDR0000257989__151/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000257989151" rid-ob="figobCDR0000257989151"><img class="small-thumb" src="/books/NBK65844.2/bin/CDR0000503953.gif" src-large="/books/NBK65844.2/bin/CDR0000503953.jpg" alt="Lumbar puncture" /></a><div class="icnblk_cntnt" id="figlgndCDR0000257989151"><h4 id="CDR0000257989__151"><a href="/books/NBK65844.2/figure/CDR0000257989__151/?report=objectonly" target="object" rid-ob="figobCDR0000257989151">Figure</a></h4><p class="float-caption no_bottom_margin">Lumbar puncture. A patient lies in a curled position on a table. After a small area on the lower back is numbed, a spinal needle (a long, thin needle) is inserted into the lower part of the spinal column to remove cerebrospinal fluid (CSF, shown in blue). <a href="/books/NBK65844.2/figure/CDR0000257989__151/?report=objectonly" target="object" rid-ob="figobCDR0000257989151">(more...)</a></p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the organs or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).</div></li></ul></div><div id="CDR0000257989__127"><h3>There is no standard staging system for adult ALL.</h3><p id="CDR0000257989__108"> The disease is described as untreated, in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>.</p><p id="CDR0000257989__94"><b>Untreated adult ALL</b></p><p id="CDR0000257989__95">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044362/" class="def">ALL</a> is newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> and has not been treated except to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">fever</a>, bleeding, or pain. </p><ul id="CDR0000257989__109"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045107/" class="def">complete blood count</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>.</div></li><li class="half_rhythm"><div>More than 5% of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046503/" class="def">blasts</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> cells).</div></li><li class="half_rhythm"><div>There are signs and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> of leukemia.</div></li></ul><p id="CDR0000257989__96"><b>Adult ALL in remission</b></p><p id="CDR0000257989__97">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044362/" class="def">ALL</a> has been treated.</p><ul id="CDR0000257989__110"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045107/" class="def">complete blood count</a> is normal.</div></li><li class="half_rhythm"><div>5% or fewer of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046503/" class="def">blasts</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> cells).</div></li><li class="half_rhythm"><div>There are no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> of leukemia other than in the bone marrow.</div></li></ul></div></div><div id="CDR0000257989__32"><h2 id="_CDR0000257989__32_">Recurrent Adult Acute Lymphoblastic Leukemia</h2><p id="CDR0000257989__33"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a> adult <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (ALL) is cancer that has recurred (come back) after
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going into <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a>. The ALL may come back in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone
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marrow</a>, or other parts of the body. </p></div><div id="CDR0000257989__34"><h2 id="_CDR0000257989__34_">Treatment Option Overview</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000257989__35">There are different types of treatment for patients with adult
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ALL. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__112">The treatment of adult ALL usually has two phases.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__39">Four types of standard treatment are used: </a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__52">New types of treatment are being tested in clinical trials.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__141">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__143">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__174">Patients with ALL may have late effects after treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000257989__145">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000257989__35"><h3>There are different types of treatment for patients with adult
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ALL. </h3><p id="CDR0000257989__37">Different types of treatment are available for patients with adult
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (ALL). Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346525/" class="def">standard</a> (the currently used treatment), and some are
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being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A
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treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current
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treatments or obtain information on new treatments for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>.
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When clinical trials show that a new treatment is better than the
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standard treatment, the new
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treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. </p></div><div id="CDR0000257989__112"><h3>The treatment of adult ALL usually has two phases.</h3><p id="CDR0000257989__114">The treatment of adult <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044362/" class="def">ALL</a> is done in phases:</p><ul id="CDR0000257989__115"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046560/" class="def">Remission induction therapy</a>: This is the first phase of treatment. The goal is to kill the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>. This puts the leukemia into <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046219/" class="def">Post-remission therapy</a>: This is the second phase of treatment. It begins once the leukemia is in remission. The goal of post-remission therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045866/" class="def">relapse</a>. This phase is also called remission continuation therapy.</div></li></ul><p id="CDR0000257989__116">Treatment called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000437045/" class="def">central nervous system (CNS) sanctuary therapy</a> is usually given during each phase of therapy. Because standard <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> may not reach leukemia cells in the CNS (brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>), the cells are able to "find sanctuary" (hide) in the CNS. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">Systemic chemotherapy</a> given in high <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">intrathecal chemotherapy</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the brain are able to reach leukemia cells in the CNS. They are given to kill the leukemia cells and lessen the chance the leukemia will <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recur</a> (come back). CNS sanctuary therapy is also called CNS prophylaxis.</p></div><div id="CDR0000257989__39"><h3>Four types of standard treatment are used: </h3><div id="CDR0000257989__41"><h4>Chemotherapy </h4><p id="CDR0000257989__73"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (intrathecal chemotherapy), an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer being treated.</p><p id="CDR0000257989__117">Intrathecal chemotherapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used to lessen the chance leukemia cells will spread to the brain and spinal cord, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis. <div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000257989153" co-legend-rid="figlgndCDR0000257989153"><a href="/books/NBK65844.2/figure/CDR0000257989__153/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000257989153" rid-ob="figobCDR0000257989153"><img class="small-thumb" src="/books/NBK65844.2/bin/CDR0000539773.gif" src-large="/books/NBK65844.2/bin/CDR0000539773.jpg" alt="Intrathecal chemotherapy" /></a><div class="icnblk_cntnt" id="figlgndCDR0000257989153"><h4 id="CDR0000257989__153"><a href="/books/NBK65844.2/figure/CDR0000257989__153/?report=objectonly" target="object" rid-ob="figobCDR0000257989153">Figure</a></h4><p class="float-caption no_bottom_margin">Intrathecal chemotherapy. Anticancer drugs are injected into the intrathecal space, which is the space that holds the cerebrospinal fluid (CSF, shown in blue). There are two different ways to do this. One way, shown in the top part of the figure, is to <a href="/books/NBK65844.2/figure/CDR0000257989__153/?report=objectonly" target="object" rid-ob="figobCDR0000257989153">(more...)</a></p></div></div></p><p id="CDR0000257989__159">See <a href="http://www.cancer.gov/about-cancer/treatment/drugs/leukemia#1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Lymphoblastic Leukemia</a> for more information.</p></div><div id="CDR0000257989__44"><h4>Radiation therapy
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</h4><p id="CDR0000257989__74"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are two types of radiation therapy. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer. </p><p id="CDR0000257989__196">External radiation therapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used this way, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis.</p></div><div id="CDR0000257989__118"><h4>Chemotherapy with stem cell transplant</h4><p id="CDR0000257989__120"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a> is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">Stem cells</a> (immature blood cells) are removed from the blood or bone marrow of the patient or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a> and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. These reinfused stem cells grow into (and restore) the body's blood cells.</p><p id="CDR0000257989__160">See <a href="http://www.cancer.gov/about-cancer/treatment/drugs/leukemia#1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Lymphoblastic Leukemia</a> for more information.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000257989195" co-legend-rid="figlgndCDR0000257989195"><a href="/books/NBK65844.2/figure/CDR0000257989__195/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000257989195" rid-ob="figobCDR0000257989195"><img class="small-thumb" src="/books/NBK65844.2/bin/CDR0000765030.gif" src-large="/books/NBK65844.2/bin/CDR0000765030.jpg" alt="Stem cell transplant" /></a><div class="icnblk_cntnt" id="figlgndCDR0000257989195"><h4 id="CDR0000257989__195"><a href="/books/NBK65844.2/figure/CDR0000257989__195/?report=objectonly" target="object" rid-ob="figobCDR0000257989195">Figure</a></h4><p class="float-caption no_bottom_margin">Stem cell transplant. (Step 1): Blood is taken from a vein in the arm of the donor. The patient or another person may be the donor. The blood flows through a machine that removes the stem cells. Then the blood is returned to the donor through a vein in <a href="/books/NBK65844.2/figure/CDR0000257989__195/?report=objectonly" target="object" rid-ob="figobCDR0000257989195">(more...)</a></p></div></div></div><div id="CDR0000257989__130"><h4>Targeted therapy </h4><p id="CDR0000257989__158"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.</p><p id="CDR0000257989__132">Targeted therapy drugs called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">tyrosine kinase inhibitors</a> are used to treat some types of adult ALL.
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These drugs block the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a>, tyrosine kinase, that causes stem cells to develop into more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046503/" class="def">blasts</a>) than the body needs. Three of the drugs used are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">imatinib mesylate</a> (Gleevec), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000484435/" class="def">dasatinib</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000575396/" class="def">nilotinib</a>.</p><p id="CDR0000257989__161">See <a href="http://www.cancer.gov/about-cancer/treatment/drugs/leukemia#1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Lymphoblastic Leukemia</a> for more information.</p></div></div><div id="CDR0000257989__52"><h3>New types of treatment are being tested in clinical trials.
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</h3><p id="CDR0000257989__140">This summary section describes treatments that are being studied in
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clinical trials. It may not mention every new treatment being studied.
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Information about clinical trials is available from the
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<a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000257989__57"><h4>Biologic therapy</h4><p id="CDR0000257989__59"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045617/" class="def">Biologic therapy</a> is a treatment that uses the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
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</p></div></div><div id="CDR0000257989__141"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000257989__141_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000257989__141_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000257989__141_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000257989__143"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000257989__143_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000257989__143_30">Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044267/" class="def">NCI's</a> listing of clinical trials. </p></div><div id="CDR0000257989__174"><h3>Patients with ALL may have late effects after treatment.</h3><p id="CDR0000257989__176"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">Side effects</a> from cancer treatment that begin during or after treatment and continue for months or years are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>. Late effects of treatment for ALL may include the risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">second cancers</a> (new types of cancer). Regular <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> exams are very important for long-term <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a>.</p></div><div id="CDR0000257989__145"><h3>Follow-up tests may be needed.</h3><p id="CDR0000257989__145_33">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000257989__145_34">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p></div></div><div id="CDR0000257989__62"><h2 id="_CDR0000257989__62_">Treatment Options for Adult Acute Lymphoblastic Leukemia</h2><div id="CDR0000257989__63"><h3>Untreated Adult Acute Lymphoblastic Leukemia
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</h3><p id="CDR0000257989__64"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatment</a> of adult <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (ALL) during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046560/" class="def">remission induction</a> phase includes the following:</p><ul id="CDR0000257989__88"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">Tyrosine kinase inhibitor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">imatinib mesylate</a>, in certain patients. Some of these patients will also have combination chemotherapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046609/" class="def">Supportive care</a> including
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045967/" class="def">antibiotics</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cell</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelet</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046001/" class="def">transfusions</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046472/" class="def">CNS prophylaxis therapy</a> including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">intrathecal</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic</a>) with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the brain.</div></li></ul><p id="CDR0000257989__TrialSearch_63_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=39077&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">untreated adult acute lymphoblastic leukemia</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000257989__66"><h3>Adult Acute Lymphoblastic Leukemia in Remission</h3><p id="CDR0000257989__67"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatment</a> of adult <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044362/" class="def">ALL</a> during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046219/" class="def">post-remission</a> phase includes the following:
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</p><ul id="CDR0000257989__121"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">Tyrosine kinase inhibitor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046472/" class="def">CNS prophylaxis </a><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">intrathecal</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic</a>) with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the brain.</div></li></ul><p id="CDR0000257989__TrialSearch_66_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=39084&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">adult acute lymphoblastic leukemia in remission</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000257989__69"><h3>Recurrent Adult Acute Lymphoblastic Leukemia</h3><p id="CDR0000257989__70"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatment</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> adult <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044362/" class="def">ALL</a> may include the following:</p><ul id="CDR0000257989__71"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.
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</div></li><li class="half_rhythm"><div>Low-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> as
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269448/" class="def">palliative care</a> to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">Tyrosine kinase inhibitor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000484435/" class="def">dasatinib</a> for certain patients.</div></li></ul><p id="CDR0000257989__85">Some of the treatments being studied in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for recurrent adult ALL include the following:</p><ul id="CDR0000257989__86"><li class="half_rhythm"><div>A clinical trial of stem cell transplant using the
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patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cells</a>.</div></li><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045617/" class="def">biologic therapy</a>.</div></li><li class="half_rhythm"><div>A clinical trial of new anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a>.</div></li></ul><p id="CDR0000257989__TrialSearch_69_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=38716&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">recurrent adult acute lymphoblastic leukemia</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000257989__133"><h2 id="_CDR0000257989__133_">To Learn More About Adult Acute Lymphoblastic Leukemia</h2><p id="CDR0000257989__134">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about adult acute lymphoblastic leukemia, see the following: </p><ul id="CDR0000257989__162"><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Leukemia Home Page</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/wyntk-leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">What You Need to Know About™ Leukemia
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</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/treatment/drugs/leukemia#1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Lymphoblastic Leukemia</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant/stem-cell-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Blood-Forming Stem Cell Transplants</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Cancer Therapies</a></div></li></ul><p id="CDR0000257989__133_40">For general <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other resources from the National Cancer Institute, see the following:</p><ul id="CDR0000257989__133_41"><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/diagnosis-staging/staging/staging-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Staging</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="http://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000257989__AboutThis_1"><h2 id="_CDR0000257989__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000257989__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000257989__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="http://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000257989__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000257989__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000257989__AboutThis_6">This PDQ cancer information summary has current information about the treatment of acute lymphoblastic leukemia. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000257989__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000257989__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
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</p><p id="CDR0000257989__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000257989__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000257989__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000257989__AboutThis_12">Clinical trials are listed in PDQ and can be found online at <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000257989__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000257989__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000257989__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000257989__AboutThis_21">National Cancer Institute: PDQ® Adult Acute Lymphoblastic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/types/leukemia/patient/adult-all-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/types/leukemia/patient/adult-all-treatment-pdq</a>. Accessed <MM/DD/YYYY>.</p><p id="CDR0000257989__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 scientific images.
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</p></div><div id="CDR0000257989__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000257989__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="http://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000257989__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000257989__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="http://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65844.2/?report=reader">PubReader</a></li><li><a href="/books/NBK65844.2/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65844" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65844" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Adult Acute Lymphoblastic Leukemia Treatment (PDQ®): Patient Version. 2015 Sep 17. In: PDQ Cancer Information Summaries [Internet]. 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