Targeted cancer drugs and immunotherapy for acute lymphoblastic leukaemia (ALL)

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack the cancer. They are called immunotherapies. CAR T-cell is a type of immunotherapy you might have to treat ALL. 

Targeted cancer drugs

There are different types of targeted cancer drugs. For ALL, you might have:

• tyrosine kinase inhibitors or TKIs
• monoclonal antibodies or MABs

Tyrosine kinase inhibitors

The main type of targeted cancer drug used for ALL is tyrosine kinase inhibitors or TKIs. They block signals from a protein (enzyme) called tyrosine kinase. Tyrosine kinases help to send growth signals in cells, so blocking them stops the cell growing and dividing.

You might have TKIs if you have a type of ALL called Philadelphia positive ALL (Ph+ ALL). About 20 to 30 out of every 100 people with ALL (about 20 to 30%) have this type.

You most often have a TKI called imatinib (Glivec). You take it as a tablet. You usually have it alongside chemotherapy once a day for the whole of treatment.

You might have a different TKI if the ALL comes back, such as:

• dasatinib (Sprycel)
• ponatinib (Iclusig)

We have specific information about each of these drugs on our cancer drugs A to Z list

Monoclonal antibodies (MABs)

You might have a monoclonal antibody if you have a type of ALL called precursor B cell ALL that has come back or is not responding to treatment.

Monoclonal antibodies work in different ways. In ALL they work by recognising and finding specific proteins on leukaemia cells. This helps the immune system to find and destroy them.

Some of the monoclonal antibodies you might have are:

• rituximab
• blinatumomab (Blincyto)
• inotuzumab ozogamicin (Besponsa)

You have it through a drip into your bloodstream (intravenously).

CAR T-cell therapy

CAR T-cell therapy is a new type of immunotherapy that is available on the NHS for some people with a type of ALL called B cell ALL. You might have CAR T-cell therapy if:

• you're aged 25 or under and you have ALL that is not responding well to treatment
• you have ALL that has come back or is no longer responding to treatment (relapsed or refractory ALL)

T cells are a type of white blood cell that moves around the body to find and destroy defective cells. When you come into contact with a new infection or disease, the body makes T cells to fight that specific infection or disease.

How does CAR T-cell therapy work?

A specialist team takes a sample of T cells from your blood. This process is called apheresis.

In the laboratory, they change the T cells. You might hear this called genetically engineering the T cell. The T cell is now a CAR T-cell. CAR stands for chimeric antigen receptor. These CAR T-cells are designed to recognise and target a specific protein on the cancer cells.

These changed T cells grow and multiply in the laboratory. Once there are enough cells you have a drip containing these cells back into your bloodstream. The aim is for the CAR T-cells to then recognise and attack the cancer cells.

Tisagenleucleucel is one of the current CAR T-cell therapies that you might have for ALL.

Side effects

The side effects depend on the drug you are having. Some of the common side effects include:

An increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should let your doctor or nurse know urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Skin changes

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Tummy (abdominal) pain

Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help. 

Flu-like symptoms

You may have headaches, muscle aches (myalgia), a high temperature and shivering. You should contact your advice line urgently if you have these symptoms.

Headaches

Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.

Dizziness

This drug might make you feel dizzy. Don’t drive or operate machinery if you have this.