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Phases of treatment for acute lymphoblastic leukaemia (ALL)

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

  • induction also called remission induction
  • consolidation
  • intensification also called delayed intensification
  • maintenance 

Treatment for ALL usually takes between 2 and 3 years. The maintenance phase of treatment takes up most of this time. If you have a stem cell or bone marrow transplant the treatment time is much shorter.

ALL treatment is complicated, so the treatment varies. Your treatment team will talk to you about your treatment plan.

Induction or remission induction

The aim of the induction phase is to destroy as many the leukaemia cells as possible. If there is no sign of leukaemia in your blood and bone marrow after treatment it's called a complete remission (CR).

What treatment do I have?

You start treatment quite quickly after getting 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 until you have recovered. This is usually about a month. There are different combinations of drugs you might have.

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. This allows your doctor a bit of time to get 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 need blood or platelet transfusions depending on your blood test results.

If you have Philadelphia positive ALL you have a targeted cancer drug. This drug is called imatinib (Glivec), and you have it alongside your chemotherapy. You take this as a tablet every day. This continues throughout your treatment. 

You can watch this short video that explains what Philadelphia positive ALL is.

Chemotherapy into the spine

Leukaemia cells can sometimes travel to the brain and spinal cord (the central nervous system or CNS). So as part of your induction treatment you have chemotherapy into the fluid that circulates around the spinal cord and brain. This is called intrathecal chemotherapy. You may also have steroids into the CNS fluid.

Intrathecal chemotherapy treats leukaemia cells that are in the CNS. Or you have it to prevent leukaemia cells spreading to the CNS (CNS prophylaxis). You will also have this as part of other phases of your treatment.

You have intrathecal chemotherapy in the same way you have a lumbar puncture.

What happens next

After you finished the induction phase you have a bone marrow test. This is to check how well the treatment has worked. You might hear your doctors use the term MRD. This stands for minimal residual disease. This is a sensitive test to check if there are any remaining leukaemia cells in your body.

You move on to the next phase of treatment if you are in remission Open a glossary item. If you’re not in remission you usually have more chemotherapy.

Consolidation and intensification

The aim is to get rid of any leukaemia cells that might still be there and to stop them from coming back. You have one or more of the following treatments:

  • more chemotherapy
  • steroids
  • imatinib if you have a type of leukaemia called Philadelphia positive leukaemia
  • a donor transplant
  • a transplant with your own blood stem cells, but this is rare

You may also have treatment with CAR T-cell therapy if you are taking part in a clinical trial.

The 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

Chemotherapy

In these phases you're likely to have some of the same chemotherapy drugs you had in the induction phase. You will also have some others. You usually have higher amounts (doses) of the drugs so the treatment is stronger.

You have your treatment in cycles Open a glossary item, also known as blocks. The number of consolidation blocks you have may be different to someone else with ALL. And not everyone has the intensification block. This is usually based on your general health and level of fitness.

Your treatment team will go into the detail of your treatment plan with you. 

Donor transplant

A donor transplant means having bone marrow or stem cells from someone else. This is also known as an allogeneic transplant or allograft. Before the transplant you have either:

  • high dose chemotherapy
  • radiotherapy to the whole body (total body irradiation or TBI) and high dose chemotherapy.

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

What happens next

You usually start maintenance therapy after finishing your consolidation therapy.

Maintenance

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

What to expect

You usually have low dose chemotherapy and short courses of steroids for around 2 years. You might also have intrathecal chemotherapy. If you have Philadelphia positive leukaemia you continue to take imatinib until treatment ends. You have maintenance treatment 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. 

If you are having treatment as part of a clinical trial, your maintenance treatment might include a targeted cancer drug such as inotuzumab ozogamicin.

What happens next

Your doctor follows you up closely after you finish maintenance treatment. 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

You usually have treatment for ALL as part of a clinical trial. 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: 
28 Jul 2021
Next review due: 
28 Jul 2024
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  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.