Types of treatment for acute lymphoblastic leukaemia (ALL) | Cancer Research UK
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Types of treatment for acute lymphoblastic leukaemia

The main treatment for ALL is chemotherapy. Other treatments you may have include steroids, growth factors, radiotherapy and bone marrow transplant or stem cell transplant. Treatment for acute lymphoblastic leukaemia varies depending on your type of ALL, your general health, your age and level of fitness.

The phases of treatment for ALL

Doctors divide treatment for ALL into different phases. The first phase is called remission induction. You have treatment with chemotherapy and usually steroids. The aim is to destroy the leukaemia cells and get you into remission. In remission, there are no leukaemia cells in your blood or bone marrow.

Then you have consolidation treatment to stop your leukaemia coming back. This may mean more chemotherapy, or a transplant of bone marrow or stem cells.

The last phase of ALL treatment is maintenance therapy. It helps to keep the leukaemia in remission for longer. It usually involves having low dose chemotherapy and short courses of steroids for up to 2 years.

Treating ALL that comes back or resists treatment

Sometimes leukaemia cells are left in the bone marrow after your treatment. This is called resistant leukaemia. You may have more chemotherapy, or possibly a stem cell transplant. If the leukaemia comes back after a period of remission it is called a relapse. Again, you may have more chemotherapy or a stem cell transplant.
 

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The main treatments for ALL

Most people with acute lymphoblastic leukaemia start treatment quickly after diagnosis. The main treatment is chemotherapy. Other treatments you might need include blood transfusions, platelet transfusions and antibiotics.

There are other treatments you may have. There is detailed information on all these treatments in this section. 

 

How your doctor decides on your options

The treatment for acute lymphoblastic leukaemia varies depending on

  • The type of ALL
  • Your general health
  • Your age and level of fitness

Different types of ALL may be treated differently. There is information about this in each treatment section. And your doctor will be able to explain the treatments suitable in your case.

Researchers and doctors continue to look for better combinations of treatments, as well as new treatments. They test these in clinical trials. Your doctor may suggest that you join a trial. Our trials and research section has information about understanding clinical trials, including what it is like to take part.

You can find details of individual trials for acute leukaemia in the clinical trials database.

 

The phases of treatment for ALL

Doctors divide treatment for acute lymphoblastic leukaemia into different phases. This treatment usually takes 2 years. The maintenance treatment takes up most of this time. It is a long time to have treatment and we have information on coping with ALL in this section. The good news is that most people do very well with treatment. The phases are explained below.

 

Getting rid of ALL (remission induction)

The aim of the first phase of treatment is to destroy the leukaemia cells. In remission, there are no leukaemia cells in your blood or bone marrow. Doctors call this first phase of treatment remission induction. You will need to stay in hospital for about a month.

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 have them into a vein through your central line.

The chemotherapy drugs kill off many of your normal bone marrow cells as well as the leukaemia cells. But normal bone marrow cells usually come back after 2 to 3 weeks, and start making blood cells again.

If you are not in remission after this treatment, you will need more chemotherapy. You may have a different combination of drugs from the first time. 

The chemotherapy travels through the bloodstream to most parts of the body but does not 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 may have chemotherapy given into the fluid that circulates around the spine and brain (called intrathecal chemotherapy). You may also have radiotherapy to the brain and spine. If the leukaemia comes back in the testes (in men), you will have more chemotherapy or radiotherapy.

If you have Philadelphia positive ALL you may have a biological therapy called imatinib (Glivec) as well as chemotherapy.

This remission induction phase of treatment destroys nearly all of the leukaemia cells. But a very small number may survive. So, the leukaemia is likely to come back without further treatment. To try to stop this, you need to have the next stage of treatment called consolidation therapy.

 

Treatment to stop ALL coming back (consolidation therapy)

Once there is no sign of the leukaemia, you will need treatment to stop it coming back. Doctors call this consolidation treatment. It may mean

  • More chemotherapy
  • A donor transplant
  • A transplant with your own blood stem cells but this is rare

A donor transplant means having high dose chemotherapy followed by bone marrow or stem cells from someone else. Your doctor may call this an allogeneic transplant (pronounced a-low-gen-ay-ik).

A transplant with your own cells is called an autologous stem cell transplant. This is not often used for ALL. You have stem cells collected, then high dose chemotherapy followed by the stem cells back through a drip. You may have radiotherapy as well.

Bone marrow and stem cell transplants are intensive treatments. This link takes you to information about intensive treatment.

The consolidation treatment you have depends on many factors. These include

  • Whether your lumbar puncture tests find leukaemia cells in the fluid around your brain and spinal cord
  • Whether you have leukaemia after treatment for a previous cancer
  • Whether your leukaemia is completely in remission
  • How many times you had chemotherapy before your leukaemia went into remission
  • Your general level of fitness and health

Your doctor will also take into account your own wishes and feelings about treatment.

If your leukaemia goes into a complete remission after your induction chemotherapy, you may have more chemotherapy. You may be able to have a stem cell transplant using your own blood stem cells, but this is not often used.

If you had more than one induction chemotherapy course to get you into remission, your doctor may suggest a donor transplant, if a donor is available.

A lot of research is looking into the role of transplants in treating adult acute leukaemia. The research is to make these treatments more successful and safer. This is very intensive treatment that can make you feel very ill for some time. You need to understand all the risks before you and your doctor decide what to do. Unfortunately, sometimes people die due to the treatment, rather than from the leukaemia itself.

Transplants can have long term side effects. These are likely to lower your quality of life after you finish treatment. You need to fully understand this before you agree to any treatment. You will need to discuss all these benefits and disadvantages with your specialist before making a decision.

If you have a transplant after remission induction and consolidation, your overall treatment may be shorter and finish in less than a year.

 

Keeping ALL away long term (maintenance therapy)

The last phase of ALL treatment is maintenance therapy. It helps to keep the leukaemia in remission for longer. It usually involves having low dose chemotherapy and short courses of steroids for up to 2 years. It may also include more treatment to your brain and spine.

 

Treating ALL that comes back or resists treatment

Sometimes, tests find leukaemia cells in the bone marrow after you have had treatment. This is called resistant leukaemia. You may have more chemotherapy, using different drugs from the first time. Or your doctor may suggest a stem cell transplant, as part of a clinical trial.

If you go into remission, the leukaemia sometimes comes back later on. This is called a relapse. Treatment for relapsed leukaemia depends on

  • How long you were in remission
  • Your age and general level of fitness and health
  • Certain features of the leukaemia cells

You may have the same drugs you had when you first went into remission. Or you may have a different combination of chemotherapy drugs. Your doctor may also suggest a stem cell transplant. Your doctor will discuss your treatment options with you.

Testicular relapse

For men and boys with ALL, there is a risk that leukaemia cells can spread to the testicles. If you have any swelling or lumps in your testicles, you must tell your doctor straight away.

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Updated: 7 May 2015