About chemotherapy for ALL
This page tells you about chemotherapy for acute lymphoblastic leukaemia (ALL). There is information about
About chemotherapy for acute lymphoblastic leukaemia
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. You usually have chemotherapy directly into your bloodstream for leukaemia. You usually have a central line put in. It stays in for as long as you need it.
Getting rid of the ALL (induction)
Your first treatment aims to get your leukaemia into remission. It is called induction therapy. You have several different chemotherapy drugs and a steroid. The treatment causes side effects. Most people need to stay in hospital for about a month while they are having treatment and recovering.
Treatment to stop ALL coming back (consolidation)
When your leukaemia has gone into remission you have consolidation treatment. You may have high doses of chemotherapy. Or you may have intensive treatment, with a bone marrow transplant or stem cell transplant.
Stopping ALL spreading into the brain or spinal fluid
Leukaemia cells can go into the brain and spinal cord. To try and stop this you have chemotherapy injected into the fluid that circulates around the brain and the spinal cord. This is like having a lumbar puncture.
Keeping the leukaemia away, long term
Maintenance treatment is more chemotherapy, but in lower doses. You will be able to have this as an outpatient. Including maintenance treatment, the whole ALL treatment course lasts for about 2 years.
You can view and print the quick guides for all the pages in the treating ALL section.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. As they circulate in the blood, they can reach cancer cells almost anywhere in your body.
You have chemotherapy directly into your bloodstream for leukaemia. You usually have a central line put in. This plastic tube goes into your chest and into one of the largest veins in your body.
You have the tube put in under local or general anaesthetic. The last 15cm (6 inches) or so of the tube hangs out of your chest. Your doctor or nurse can use the tube to give any drug into a vein and to take blood samples. The tube has a clamp and a cap on to keep it sealed when it is not in use.
The tube stays in for as long as you need it. A nurse will show you how to look after it and keep it clean.
Instead of a central line, you may have another type of line called a portacath. This is a small chamber put under the skin of your chest under local anaesthetic. The chamber connects to a tube inside your chest, which goes into a large vein. Your doctors and nurses push a fine needle through the skin into the chamber to give your chemotherapy.
Most people who have chemotherapy for acute lymphoblastic leukaemia have to stay in hospital. 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. You have treatment for a few days, then a rest period. After the rest period, you may have more treatment, and so on.
The treatment you have at the beginning aims to get your leukaemia into remission. Remission means there are no leukaemia cells in your blood or bone marrow. This phase of treatment is called induction therapy or remission induction.
You have several different chemotherapy drugs and a steroid. The treatment causes side effects. For example, you will be at risk of picking up infections and bleeding. You will need to have antibiotics and blood transfusions. Most people need to stay in hospital for about a month while they are having this treatment and recovering. Whilst in hospital the doctors and nurses will be able to control the side effects of the treatment.
Leukaemia cells release uric acid as they die. High levels of uric acid in the body can damage the kidneys. So you will also need to have either a drug called allopurinol or a drug called rasburicase to stop uric acid building up.
We have more detailed information about the side effects of chemotherapy for ALL.
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 may have high doses of one of the chemotherapy drugs that you had as part of your induction treatment. You may be able to have some of this treatment as an outpatient.
Or you may have intensive treatment, with a bone marrow or stem cell transplant.
Your doctor may call this CNS prophylaxis. CNS stands for central nervous system. Prophylaxis just means prevention.
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.
Doctors call this intrathecal chemotherapy. It is like having a lumbar puncture. You will have to lie flat or with your head slightly lower than your feet for a few hours. You may also have a headache or feel sick afterwards.
You may also have radiotherapy to your brain to kill any leukaemia cells there (known as prophylactic cranial irradiation).
This is known as maintenance treatment. It is more chemotherapy, but in lower doses than you have in the other phases of treatment. You will be able to have this as an outpatient. Including maintenance treatment, the whole ALL treatment course lasts for about 2 years.
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