Chemotherapy is the main treatment for acute lymphoplastic leukaemia (ALL). Get an overview of the phases of treatment and what to expect.
You will probably have to stay in hospital whilst having chemotherapy for ALL. This is because:
- the treatment can make you feel very ill for some time
- you will have side effects that the hospital staff can help control
- you may need antibiotics into a vein to treat infection
Your exact treatment depends on a number of factors but you can usually divide it into phases. For ALL, you have several different chemotherapy drugs in cycles of treatment.
What chemotherapy is
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
How you have chemotherapy
You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
The pharmacists make chemotherapy for each person individually. They do this once your blood test results have come through. It’s worked out based on your weight, height and general health.
Phases of treatment for ALL
Your treatment is in 3 phases:
- getting rid of ALL (remission induction)
- treatment to stop ALL coming back (consolidation)
- keeping ALL away long term (maintenance)
Getting rid of ALL (remission induction)
Aim of the induction phase
The aim of the induction phase is to destroy the leukaemia cells. It's called remission induction. In remission there is no sign of the leukaemia in your blood or bone marrow.
What treatment to expect
The main treatment is chemotherapy.
The chemotherapy drugs kill off many of your bone marrow cells as well as the leukaemia cells. So you might need to stay in hospital for about a month until you have recovered.
Before you start the chemotherapy, you may need to have blood or platelet transfusions. Then you have treatment with chemotherapy and usually, steroids. You have a number of chemotherapy drugs over a few days.
You might have a biological therapy called imatinib (Glivec) as well as chemotherapy, if you have Philadelphia chromosome positive ALL.
Chemotherapy into the spine
The chemotherapy travels through the bloodstream to most parts of the body but doesn't reach the brain or the testicles. Leukaemic cells can sometimes go into the brain or the testes in men. So, as part of your remission induction treatment you might have chemotherapy given into the fluid that circulates around the spinal cord and brain (called intrathecal chemotherapy).
You might also have radiotherapy to the brain and spinal cord.
What happens next
You will need more chemotherapy if you are not in remission after this treatment.
You also have treatment which aims to stop the ALL spreading into the brain or spinal fluid. This is called CNS prophylaxis.
Treatment to stop ALL coming back (consolidation)
The second phase of treatment is called consolidation treatment. You have this when your leukaemia has gone into remission. There are different types of consolidation treatment. You might have high doses of one of the chemotherapy drugs that you had as part of your induction treatment. You might be able to have some of this treatment as an outpatient.
A common chemotherapy combination includes:
Some people have high dose chemotherapy and radiotherapy followed by a bone marrow or stem cell transplant.
Stopping ALL spreading into the brain or spinal fluid
This is also called CNS prophylaxis.
Leukaemia cells can go into the brain and spinal cord. Chemotherapy into a vein can’t get through to kill them. So, you have chemotherapy injected into the fluid that circulates around the brain and the spinal cord (the cerebrospinal fluid, CSF). The chemotherapy drug is usually methotrexate.
Having this treatment is like having a lumbar puncture.
You might also have radiotherapy to your brain to kill any leukaemia cells there. This is called prophylactic cranial irradiation.
Keeping ALL away, long term (maintenance)
This is known as maintenance treatment. It is more chemotherapy, but in lower doses than you have in the other phases of treatment. The drugs that you are likely to have during maintenance include:
- prednisolone (a steroid)
You will be able to have this as an outpatient.
Including maintenance treatment, the whole ALL treatment course lasts for about 2 years.
Drugs to control the effects of ALL treatment
Chemotherapy drugs can cause some effects that need to be controlled. Substances from dying leukaemia cells can cause problems with your liver and kidneys. This is called tumour lysis syndrome.
To control this, you may have medicines such as allopurinol tablets. These tablets help the body to process the waste materials from the dead leukaemia cells. If your white blood cell levels are very high, or if you have T cell ALL, you may have a medicine called rasburicase by drip, instead of allopurinol tablets.
Chemotherapy drugs increase your risk of infection. To help stop you getting infections from the natural bacteria that live in the gut, you might take tablets called gut sterilisers. You might also need tablets and mouthwashes to help stop mouth infections.
Treatment for ALL can cause side effects.
These can include:
- a drop in your blood cell counts
- feeling and being sick
- a sore mouth and mouth ulcers
- loss of fertility
Dietary or herbal supplements
We don't yet know much scientifically about how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.
It is very important to tell your doctors if you take any supplements, or if you are prescribed them by alternative or complementary therapy practitioners.
Talk to your specialist about any other tablets or medicines you take while you are having active treatment.
Some studies seem to suggest that fish oil preparations might make some chemotherapy drugs work less well. If you take or are thinking of taking these supplements, talk to your doctor to find out whether they could affect your treatment.