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Phases of treatment

Treatment for acute lymphoblastic leukaemia (ALL) is divided into 3 phases. These are:

  • remission induction
  • consolidation therapy
  • maintenance therapy

Treatment for ALL usually takes between 2 and 3 years. The maintenance phase of treatment takes up most of this time.

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 therapy)

Aim of consolidation therapy

Consolidation therapy is when the treatment is made stronger. Your doctor might also call it the intensification phase. The aim is to get rid of any leukaemia cells that might still be there and to stop it from coming back.

This phase of treatment might take a few months.

What treatment to expect

You have one of the following:

  • more chemotherapy
  • a donor transplant
  • a transplant with your own blood stem cells, but this is rare

A donor transplant means having bone marrow or stem cells from someone else. This is called an allogeneic transplant or allograft. Before the transplant you have either high dose chemotherapy or radiotherapy to the whole body (total body irradiation, TBI) and high dose chemotherapy.

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

  • whether your lumbar puncture tests show leukaemia cells in the fluid around your brain and spinal cord
  • whether your leukaemia is completely in remission
  • how many times you had chemotherapy before your leukaemia went into remission
  • whether you developed leukaemia after treatment for another cancer
  • your general health and level of fitness

What happens next

You usually start maintenance therapy after finishing your consolidation therapy.

If you have a transplant you won’t need maintenance therapy. Your transplant team follows you up very closely once you are well enough to go home.

Keeping ALL away long term (maintenance therapy)

The last phase of ALL treatment is maintenance therapy. It helps to keep the leukaemia in remission.

What to expect

You usually have low dose chemotherapy and short courses of steroids for around 2 years. You also have intrathecal chemotherapy. You have your treatment in cycles, also known as blocks. 

You see your doctor every few months to check how you are getting on and to keep an eye on your blood counts. 

Sometimes you may need blood transfusions or antibiotics if you have an infection. 

What happens next

Your doctor follows you up closely after you finish maintenance therapy. You have regular blood tests and meet with your doctor to see how you are.  

You can still contact your specialist nurse between appointments if you have any problems.

Clinical trials

Your doctor may ask you to take part in a clinical trial as part of your treatment. Doctors and researchers do trials to:

  • improve treatment
  • make existing treatments better
  • develop new treatments

Talk to your doctor or clinical nurse specialist if you are interested in joining a clinical trial.

Last reviewed: 
15 May 2018
  • Acute lymphoblastic leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up
    D Hoezler and others
    Annals of Oncology, 2016. Volume 27, Supplement 5, Pages 69-82

  • Hoffbrand’s Essential Haematology (7th Edition)
    AV Hoffbrand and PAH Moss
    Wiley Blackwell, 2016

  • Cancer: Principles and Practice of Oncology (10th edition)
    VT De Vita, TS Lawrence and SA Rosenberg
    Lippincott, Williams and Wilkins, 2015 

  • Cancer and its management (7th edition)
    J Tobias and D Hochhauser
    Wiley-Blackwell, 2015

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