Some patients have a return of ALL cells in the marrow and a decrease in normal blood cells after remission. This is called a relapse.
Patients with relapsed ALL may be
- Treated with the same drugs as newly diagnosed patients
- Given different drugs
- Given an an allogeneic stem cell transplantation if they have a matched donor.
Some patients still have ALL cells in their bone marrow after treatment. This is called refractory leukemia.
Patients with refractory ALL may be
- Treated with drugs that were not used in the first round of treatment may be given
- Givenan allogeneic stem cell transplantation if they have a matched donor.
The FDA has approved these drugs for relapsed and refractory patients.
- Inotuzumab ozogamicin (Besponsa®) is approved for the treatment of adults with relapsed or refractory B-cell precursor ALL.
- Liposomal vincristine (Marqibo®) is approved for adult patients with Ph chromosome-negative ALL who have relapsed two or more times. It is also approved for patients whose leukemia has progressed following two or more regimens of therapy.
- Nelarabine (Arranon®) is approved for patients with relapsed T-cell ALL.
- Blinatumomab (Blincyto®) is approved to treat patients with relapsed or refractory B-cell precursor ALL.
- Clofarabine (Clolar®) is approved by the FDA to treat children (from age 1 to 21) with relapsed or refractory ALL after they have received at least two prior chemotherapy regimens.
- Tisagenlecleucel (Kymriah®). This treatment is for B-cell ALL patients who are younger than 26 years and have refractory disease or have had two relapses.
Chimeric Antigen Receptor (CAR) T-Cell Therapy. Tisagenlecleucel (Kymriah®) is FDA approved for the treatment of patients up to age 25 years who experience a second or later relapse or refractory B-cell ALL. Tisagenlecleucel treatment is designed to help the body’s own immune system fight cancer. Each dose is made specifically for an individual patient. It is made using the patient’s own T cells (white blood cells that help the body to fight infections and cancer). The T cells are collected from the patient and then modified with a new gene containing a CAR protein so that the T cells can identify and kill leukemia cells with CD19 on their surface. These modified cells are infused back into the patient’s bloodstream to kill the cancer cells.
For more information about CAR T-Cell Therapy, download the free LLS booklet Chimeric Antigen Receptor (CAR) T-Cell Therapy Facts.
For information about the drugs listed on this page, visit Drug Listings.
Treatments for Relapsed/Refractory Ph+ ALL
For patients with relapsed or refractory Ph+ ALL, there are several treatment options.
A patient may receive a different tyrosine kinase inhibitors (TKI). Many Ph+ ALL patients receive imatinib (Gleevec®) during induction therapy. For those patients whose disease has relapsed dasatinib (Sprycel®), or ponatinib (Iclusig®) may be treatment options.
The TKI may be given alone or combined with other drugs. If ALL does not respond to treatment with TKIs, doctors may recommend regimens for relapsed or refractory Ph-negative ALL. These include
- Blinatumomab (This may be an treatment option for patients whose ALL has not responded to two or more TKIs.)
- Inotuzumab ozogamicin
An an allogeneic stem cell transplantation may also be an option.
- Download or order The Leukemia & Lymphoma Society's free booklet, Acute Lymphoblastic Leukemia.