Acute Lymphocytic Leukemia (ALL) is the most common cancer in children. However, this is a fairly rare cancer in adults. Most patients first discover their disease when they have recurrent infections, bleeding or extreme fatigue. As the bone marrow fills up with abnormal cancer cells (known as blasts), the normal bone marrow cells decrease in number. Thus patients may have low numbers of red blood cells (the cells that carry oxygen and nutrients), low numbers of platelets (the cells that help with clotting), and low numbers of normal white blood cells (the cells that fight infections). Untreated ALL can lead to rapid illness.

Although most children with Acute Lymphocytic Leukemia enter prolonged remissions and can be cured, the outlook for adults treated with conventional chemotherapy is not as optimistic. Only 20-30% will obtain long-term survival with standard treatment.

Treatment typically consists of aggressive chemotherapy spanning many months, and occasionally years. Many patients however are candidates for bone marrow transplantation therapy. High-risk features include very high white blood cell counts at diagnosis (above 100,000), abnormal chromosomes, central nervous system disease, and delayed response to initial chemotherapy.

Transplantation Therapy for ALL

Among patients with high-risk features, transplantation during first remission may be appropriate treatment. A recent comparative trial in ALL first remission involving 572 patients a 3 year survival rate of 47% with allogeneic transplatation, 39% with autologous transplants, but only 32% with standard dose therapy (Fiere D et al: J Clin Oncol 1993; 11:1990). The major benefit to allogeneic transplants was observed in patients with high-risk features such as Philadelphia chromosome positive disease. The decision to undergo allogeneic transplantation in first remission requires a careful assessment of treatment risks and potential benefits. Unrelated transplantation has been used in high-risk cases.

Unfortunately, most patients who receive standard dose therapy initially will suffer a relapse of their disease. In these patients, allogeneic transplantation in second remission is generally considered to be standard treatment. Results from the International Bone Marrow Transplant Registry show a 40-50% disease-free survival for adults undergoing allogeneic transplantation in first remission, but encouragingly in advanced disease 20-40% may still be cured.

The Adult Stem Cell- Bone Marrow Transplant Program of Hackensack University Medical Center has active transplant treatment protocols for Acute Lymphocytic Leukemia. For more information on this treatment or to schedule an appointment call (201) 996-5849.

ALLOGENEIC TRANSPLANT OPTIONS

For patients with Tissue-matched (HLA-matched) brother/sister bone marrow donors allogeneic transplantation treatment protocols may be appropriate. One trial uses high-dose cyclophosphamide combined with either total body irradiation or high-dose busulfan. Following this aggressive conditioning therapy, bone marrow (or peripheral blood stem cells) from an HLA-matched donor is infused. Graft-versus-host disease prevention is accomplished with combinations of tacrolimus and methotrexate. This very aggressive curative treatment requires a one-month hospitalization.

Hackensack University Medical Center’s Adult Transplant Program is also participating in a national Eastern Cooperative Group trial comparing allogeneic transplantation, autologous transplantation, and conventional dose chemotherapy in ALL. This study starts at diagnosis and uses a standard induction regimen. Patients are then assigned to various treatments as methods of preventing disease recurrence. For more information about this treatment click here.

UNRELATED TRANSPLANT TREATMENT OPTIONS

For patients lacking a family member marrow donor, the Hackensack University Medical Center Transplant Programs are participating in several unrelated transplant protocols.

The National Marrow Donor Program has enlisted over 3 million volunteer bone marrow donors. If an HLA matched unrelated donor can be located, a transplant using high-dose cyclophosphamide and total body irradiation can be performed.

Hackensack University Medical Center is also participating in a multicenter trial evaluating the use of expanded Cord Blood Cells in the treatment of cancers and blood diseases. This trial also extends the treatment options for patients without HLA Matched relative donors. For more information click here and also review ex-vivo expansion in the stem cell laboratory section.

AUTOLOGOUS TRANSPLANT OPTIONS

High-dose treatments with cyclophosphamide and either busulfan or total body irradiation can also be offered to patients who use their own marrow (or peripheral blood stem cells) as a source of transplantation stem cells. Post transplantation interleukin-2 infusions may also be used to reduce recurrence rates. For more information on autologous transplant options for ALL call (201) 996-5849.

In addition to the above transplantation treatments, the physicians at the Northern New Jersey Cancer Center are experienced in the diagnosis and treatment of this disease. All forms of standard dose treatment including initial and relapse therapies are available. For more information call (201) 996-5900.