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Decisions about treatment for childhood acute lymphoblastic leukaemia (ALL)

Research has shown that we need to give different treatment to babies that are under 1 year old when they are diagnosed. This information is for children over 1. Your hospital consultant can give you information about the treatment plan if your child is under 1.

Doctors plan your child’s treatment in one of the major children’s cancer centres. This is called the principal treatment centre (PTC). Your child has some of their treatment in this specialist centre, but some care takes place at a hospital closer to home. This hospital is called your:

  • shared care hospital
  • paediatric oncology shared care unit (POSCU)

Blood tests, dressing changes or other aspects of care might take place in your home.

Children start treatment for ALL quickly after they are diagnosed. This is because ALL can cause serious problems quickly if it’s not treated as soon as possible.

Children's cancer centres have teams of specialists who know about childhood ALL and the best way to treat it. Around 9 out of 10 children (around 90%) now survive.

The main treatment for acute lymphoblastic leukaemia (ALL) is chemotherapy.

Clinical trials

Many children having treatment for ALL have it as part of a clinical trial. The main clinical trial in the UK is called UKALL2011. Patients can join this clinical trial until the end of 2018.

We have more detailed information about this trial on our clinical trials database.

How long does treatment last?

Treatment is for:

  • around 2 years for girls
  • around 3 years for boys

Your child has most of their treatment as an outpatient.

Decisions about treatment

The specialist team make a treatment plan depending on a number of factors. These help your child’s doctors to decide on the best treatment group for your child based on the risk of their leukaemia coming back after treatment.

These factors include:

  • if your child is a boy or a girl – research has shown boys need to have longer treatment than girls to lower the risk of the leukaemia coming back after treatment
  • your child’s age (if they are under 12 months old or over 10 years old)
  • the level of white blood cells in the blood when your child is diagnosed (doctors call this the white cell count)
  • the type of cell the leukaemia started in
  • if there are leukaemia cells in the fluid around the brain or spinal cord (cerebrospinal fluid)
  • any genetic changes in the leukaemia cells themselves - rather than those inherited from parents

Doctors look for changes to chromosomes within the leukaemia cells themselves. One change leads to a type of leukaemia called Philadelphia positive (Phil +ve ALL). Up to 1 in 20 children with ALL (up to 5%) have the Philadelphia chromosome change.

Children with Philadelphia positive ALL have slightly different treatment than we talk about here. Your child’s doctor will go through the treatment plan with you.

Measuring if treatment is working

Your child’s doctors will check how well treatment is working. They do this soon after starting treatment.  One way of measuring this is by looking for minimal residual disease (MRD).

Minimal residual disease (MRD)

Minimal residual disease is a sensitive test. It can see if there are leukaemia cells still in the bone marrow, even if it looks like the ALL is in remission using other tests.

Doctors expect to see some MRD early on in treatment. It doesn’t mean your child’s leukaemia won’t go away with further treatment.

Depending on the results of the MRD test, and other tests, your child might have changes to their treatment. This is to make sure they are getting the best treatment they need.

Don't be afraid to ask your doctor or specialist nurse any questions you have about the treatment. You might want to encourage your child to ask questions too if they are able. Write down a list of questions you want to ask and to take a close friend or relative with you when you go to see the doctor.

Treatment phases

Most children take part in a trial. The treatment they have for each phase of their treatment depends on the treatment group they are in. Below is an overview of the different phases of treatment. You can find more detailed information using the links under each heading.

Diagram showing treatment phases of childhood ALL

Induction (getting rid of the leukaemia cells)

The aim of the induction phase is to try and get rid of as many leukaemia cells as possible. It's also called remission induction. In remission, there is no sign of the leukaemia in your child’s blood or bone marrow when looked at with a microscope.

The main treatments are:

  • chemotherapy
  • steroids

Around 98 out of 100 children (around 98%) go into remission after 4-6 weeks of induction chemotherapy.

They have 1-2 weeks of induction treatment in hospital. Your child stays as an inpatient on the children’s cancer ward. You can usually stay with them while they have this treatment.

Staying in hospital means their team can keep an eye on them for any problems or side effects of treatment. It also allows you to ask lots of questions and become more familiar with the team and treatment plan.

Your child has an MRD test at the end of the induction phase to check the response of the leukaemia to the treatment.

Consolidation

The aim of consolidation treatment is to:

  • lower the amount of residual leukaemia – these are the cells that the doctors looked for using the MRD test
  • try and prevent any leukaemia cells from spreading to the brain or spinal cord

The main treatment is chemotherapy. Depending on your child’s risk group consolidation treatment takes between 3 and 10 weeks. Most children have consolidation treatment as an outpatient or on the daycare ward.

Delayed Intensification

Intensification treatment aims to use strong chemotherapy drugs when there are very few leukaemia cells left in the blood or bone marrow. This is to try and further reduce the amount of leukaemia left after the first 2 phases of treatment.

The main treatments are:

  • chemotherapy
  • steroids

The drugs your child has during the intensification phase are usually the same as in induction and consolidation. Your child has most of their re-intensification treatment as an outpatient. But they might have to stay in hospital for some parts.

Maintenance

Maintenance is the longest phase of treatment. It lasts two years for girls and 3 years for boys from the start of interim maintenance. The treatment is much less intensive. It aims to mop up the few leukaemia cells that the other phases of treatment haven’t got rid of.

Your child has their maintenance treatment as an outpatient. The treatment is mainly chemotherapy. And treatment is tailored to your individual child’s blood counts.

Side effects

Immediate side effects happen while they are having treatment or very soon after it finishes. The side effects depend on the treatments your child has. Some common side effects of acute lymphoblastic leukaemia treatment include:

  • low resistance to infection
  • anaemia - low red blood cell count
  • risk of bruising and bleeding
  • tiredness (fatigue)
  • a sore mouth and tummy
  • taste changes
  • increased appetite while on steroids
  • poor mobility and balance
  • hair loss
  • nausea and vomiting
  • mood problems
  • constipation

Your child might need to go into hospital to manage these side effects. This can happen when your child is mainly having outpatient treatment. The nurses will tell you what to look out for and when to call the hospital.

Their leukaemia treatment might be put on hold until they are well enough for chemotherapy again. This is common, but this change to family life and interruption to your child’s treatment can be difficult to cope with.

Last reviewed: 
11 Jul 2018
  • Cancer in Children – Clinical Management (6th edition)
    MCG Stevens, HN Caron and A Biondi
    Oxford University Press, 2012

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