Targeted therapy for acute lymphocytic leukemia

Some people with acute lymphocytic leukemia (ALL) have targeted therapy. It uses drugs to target specific molecules (such as proteins) on the surface of cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. Targeted therapy may also be called molecular targeted therapy.

You may have targeted therapy added to the chemotherapy regimen if you have leukemia cells with the Philadelphia chromosome (called Ph+ ALL). You may also have targeted therapy if you have precursor B - ALL without the Philadelphia chromosome (called Ph- ALL) that comes back (relapses, or recurs) after treatment or doesn’t respond to other treatments (called refractory disease).

Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of targeted therapy. You may also receive other treatments.

Targeted therapy drugs commonly used for ALL

The most common targeted therapy drug used is imatinib (Gleevec). It is a type of tyrosine kinase inhibitor.

Other tyrosine kinase inhibitors are most often used to treat other types of leukemia, but they may also be used to treat ALL. These drugs include dasatinib (Sprycel), nilotinib (Tasigna), bosutinib (Bosulif) and ponatinib (Iclusig). They are used most often for relapsed ALL if imatinib was part of previous treatment or if other targeted therapy drugs cause severe side effects. Doctors may switch you to one of these drugs because ALL can sometimes become resistant to imatinib.

Blinatumomab (Blincyto) is another targeted therapy drug. It may be used to treat relapsed or refractory relapsed or refractory precursor B-cell Ph- and PH+ ALL.

Inotuzumab ozogamicin (Besponsa) may be used to treat relapsed or refractory CD22-positve B-cell precursor ALL.

Side effects

Side effects can happen with any type of treatment for ALL but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Targeted therapy doesn’t usually damage healthy cells, so it tends to cause fewer and less severe side effects than chemotherapy and radiation therapy. Chemotherapy and radiation therapy can damage healthy cells along with cancer cells.

If side effects develop with targeted therapy, they can happen any time during, immediately after or a few days or weeks after targeted therapy. Sometimes late side effects develop months or years after targeted therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of targeted therapy will depend mainly on the type of drug, the dose and your overall health. Some common side effects of targeted therapy for ALL are:

Tell your healthcare team if you have these side effects or others you think might be from targeted therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Information about specific cancer drugs

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.

Questions to ask about targeted therapy

Find out more about targeted therapy. To make the decisions that are right for you, ask your healthcare team questions about targeted therapy.

Expert review and references

  • American Cancer Society. Leukemia - Acute Lymphocytic (Adults). Atlanta, GA: American Cancer Society; 2013.
  • Drugs and Health Products, Health Canada. Regulatory Decision Summary: Besponsa. 2018: https://hpr-rps.hres.ca/reg-content/regulatory-decision-summary-detail.php?linkID=RDS00349.
  • Goekbuget N, Hoelzer D . Diagnosis and Treatment of adult acute lymphoblastic leukemia. Wiernik PH, Goldman JM, Dutcher JP & Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 20: pp. 331-354.
  • Health Canada, Drugs and Health Products. Blincyto (blinatumomab) Authorization with Conditions. 2015: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/notices-avis/conditions/blincyto_dhcpl_lapds_181723-eng.php.
  • Kebriaei P, Champlin R, de Lima M, et al . Management of acute leukemias. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014: 131: pp. 1928-1954.
  • Kurtin SE . Leukemia and myelodysplastic syndromes. Yarbro, CH, Wujcki D, & Holmes Gobel B. (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 57: pp. 1369-1398.
  • National Cancer Institute. Adult Acute Lymphoblastic Leukemia Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.