Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
Chemotherapy is the main treatment for acute lymphoblastic leukaemia (ALL). You have several different chemotherapy drugs, usually with a steroid. You may have treatment as part of a clinical trial.
Your exact treatment depends on a number of factors but you can usually divide it into phases.
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. If there is no sign of leukaemia in your blood and bone marrow after treatment it is called a complete remission (CR).
What treatment to expect
You start treatment quite quickly after being diagnosed. The main treatment is chemotherapy. You have several chemotherapy drugs over a few days.
Chemotherapy kills off many of your healthy bone marrow cells as well as the leukaemia cells. So you need to stay in hospital for about a month until you have recovered. There are different combinations of drugs your doctors might use.
You usually start taking steroids for up to a week before you start chemotherapy. This starts to get rid of some of the leukaemia cells while your doctor gets all your test results and plans your treatment.
You also take medicine and have fluid through a drip to help protect your kidneys. You take antibiotics if you have an infection. You might also need blood or platelet transfusions depending on your blood test results.
If you have Philadelphia positive ALL you have a targeted cancer drug called imatinib (Glivec) as well as chemotherapy. You take this as a tablet every day.
Chemotherapy into the spine
Leukaemia cells can sometimes travel to the brain and spinal cord (the central nervous system, CNS). So as part of your induction treatment you have chemotherapy and possibly a steroid into the fluid that circulates around the spinal cord and brain. This is called intrathecal chemotherapy.
It treats leukaemia cells that are in the CNS. Or you have it to prevent leukaemia cells spreading to the CNS (CNS prophylaxis).
Having this treatment is like having a lumbar puncture.
What happens next
A specialist doctor checks a sample of your bone marrow under a microscope after you have finished the induction phase. This is to check how well the treatment has worked.
You move on to the next phase of treatment if you are in remission (consolidation). If you’re not in remission you usually have more chemotherapy.
Treatment to stop ALL coming back (consolidation)
The second phase of treatment is called the consolidation or intensification phase. The aim is to destroy any leukaemia cells that may still be in your blood or bone marrow but can’t be picked up on tests. It reduces the risk of the leukaemia coming back.
This phase of treatment usually lasts several months.
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 stem cell or bone marrow transplant.
Keeping ALL away, long term (maintenance)
The aim of maintenance treatment is to help keep the leukaemia in remission. You have more chemotherapy, but in lower doses than in the other phases of treatment. You also have steroids. The drugs that you are likely to have during maintenance include:
- prednisolone (a steroid)
- intrathecal chemotherapy
The maintenance phase lasts for about 2 years. You usually have this as an outpatient, and most people can go back to work, school or college during this phase.
How you have chemotherapy
You can have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have it through a long line: a central line, a PICC line or a Portacath.
These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.
Treatment for ALL can cause side effects. These include:
- a drop in your blood cell counts
- feeling and being sick
- a sore mouth and mouth ulcers
- loss of fertility
- hair loss
Your doctor may offer you treatment as part of a clinical trial.
When at home
Chemotherapy for ALL can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. Your nurse will give you telephone numbers to call if you have any problems at home.