Targeted therapies and immunotherapy for acute lymphoblastic leukaemia
Targeted and immunotherapy drugs may be used to treat ALL. These drugs target something in or around the leukaemia cell that is helping it to grow or use the immune system to attack cancer cells.
About targeted therapies and immunotherapy for acute lymphoblastic leukaemia (ALL)
You may have a targeted therapy or immunotherapy drug, depending on the type of ALL you have. These drugs target something in or around the leukaemia cell that is helping it to grow. Some targeted drugs are also immunotherapy drugs. They use the immune system to find and attack cancer cells.
Your doctor or nurse will explain which type of drug is suitable for you.
Some of these drugs may only be available in certain situations. If a drug is not available to you on the NHS, there may be different ways you can still have it. Your cancer doctor can give you advice. We have more information about what to do if a treatment is not available.
Tyrosine kinase inhibitors (TKIs)
TKIs are a type of targeted therapy drug used to treat Ph+ ALL. Tyrosine kinase (TK) is a chemical messenger that tells the leukaemia cells when to develop and divide. In Ph+ ALL, the leukaemia cells make high levels of tyrosine kinase. This makes them grow in an uncontrolled way. TKI drugs block (inhibit) the TK signal, which causes the leukaemia cells to die.
You have a TKI with chemotherapy as your first treatment. They are also used if the leukaemia does not respond to treatment or comes back. You take them as tablets or capsules every day.
Side effects of TKIs
Side effects of TKIs are usually mild. They include:
- feeling sick
- diarrhoea
- tiredness
- leg aches or cramps
- an itchy rash.
These are usually more noticeable in the first 4 weeks of treatment. After that, they begin to get better. Tell your nurse or doctor if you have any side effects. There is usually something they can do to treat them.
Monoclonal antibodies
Monoclonal antibodies are targeted therapy drugs that work on the immune system. They target certain proteins on the leukaemia cells and use the immune system to attack them.
You have these drugs with chemotherapy or on their own. You have them as a drip into a vein.
Rituximab is used to treat B cell ALL if the leukaemia cells have a protein called CD20 on their surface. This is sometimes called CD20-positive leukaemia. You may be able to have rituximab as an injection under the skin after you have had some treatments as a drip.
Other monoclonal antibodies may also be used to treat B cell ALL. They target different proteins found on the leukaemia cells:
- Blinatumomab (Blincyto®) may be used if the leukaemia cells are CD19-positive. You may have it if you are in remission but have very small numbers of leukaemia cells (minimal residual disease).
- Inotuzumab ozogamicin (Besponsa®) may be used if the leukaemia cells are CD22-positive. You may have it if ALL does not go into remission with chemotherapy or if it has come back (relapsed).
Your doctor or specialist nurse can tell you more about these drugs and their side effects.
CAR-T therapy
CAR-T therapy (or CAR T-cell therapy) is an immunotherapy treatment. CART T stands for chimeric antigen receptor T-cell. This treatment involves collecting your own immune cells and changing them so they become better at fighting the leukaemia cells. These cells then target the leukaemia cells.
The type of CAR-T therapy used to treat ALL is called tisagenlecleucel (Kymriah®). It may be used to treat young people under 25 with B cell ALL if other treatment has not worked, or if ALL comes back.
CAR-T therapy is complicated and can have serious side effects. It is only suitable for a very small number of people. Currently, it is only available in a few specialist hospitals. Some people may be offered it as part of a clinical trial.
About our information
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References
Below is a sample of the sources used in our acute lymphoblastic leukaemia (ALL) information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
NICE (National Institute for Health and Care Excellence). Blood and bone marrow cancers. Available from https://pathways.nice.org.uk/pathways/blood-and-bone-marrow-cancers [accessed August 2021].
Phelan K and Advani A. Novel therapies in acute lymphoblastic leukemia. Current Hematologic Malignancy Reports. 2018.
Hoelzer D, et al. Acute lymphoblastic leukaemia: ESMO clinical practice guidelines. Annals of Oncology. 2016. 27 (Supplement 5): v69-v82.
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.
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