Treatment for childhood acute lymphoblastic leukaemia that has not gone away with treatment or has come back

Leukaemia that does not go away with treatment is called refractory leukaemia. Leukaemia that comes back after treatment is called relapsed disease.  

It can be more difficult to treat relapsed or refractory acute lymphoblastic leukaemia (ALL). But there are treatments available. And researchers are looking at how to improve treatment for children living with ALL that hasn’t gone away, or has come back.

The treatment your child needs depends on a number of factors including if:

  • the leukaemia has come back in the fluid around the brain and spinal cord
  • the leukaemia came back when they were on treatment, or how long ago they finished treatment

Treatment options

The main treatment options are:

  • chemotherapy
  • more intensive chemotherapy with a stem cell or bone marrow transplant
  • a targetes cancer drug such as blinatumomab or inotuzumab ozogamicin, followed by chemotherapy or a stem cell or bone marrow transplant
  • a clinical trial of a new cancer drug
  • CAR T-cell therapy

Your child’s consultant will talk to you about the treatment available for your child. They will give you detailed information and allow you plenty of time to ask questions. We have information on all open clinical trials looking at treating childhood ALL on our clinical trials database.

You can also call the Cancer Research UK nurses to talk things through on Freephone 0808 800 4040. Lines are open Monday - Friday, 9am to 5pm.

Stem cell or bone marrow transplant

Your child has a stem cell or bone marrow transplant after high doses of chemotherapy and sometimes radiotherapy to the whole body. 

This intensive treatment has a good chance of destroying the leukaemia cells. But it also destroys your child’s healthy stem cells in their bone marrow too.

CAR T-cell therapy

T cells move around the body to find and destroy defective cells. When you come into contact with a new infection or disease, the body makes T cells to fight that specific infection or disease.

With CAR T-cell cell treatment, a specialist collects and makes a small change to your child’s or a donors T cells. These then target the cancer cells.

This is a new and specialised treatment. We have more in depth information, including what it is and how CAR T-cells work, on our research page.

Some children and young people (up the age of 25 years) with a type of leukaemia called B cell ALL can have CAR T-cell therapy. It’s available through the Cancer Drugs Fund in England for one of the following situations:

  • newly diagnosed children or young people whose leukaemia hasn’t gone away with 2 cycles of treatment
  • their disease has come back (relapsed) following a stem cell or bone marrow transplant
  • their disease has relapsed twice or more
  • children and young people whose leukaemia had gone away with treatment, but it’s come back, and chemotherapy isn’t working now
  • their disease has come back once but they can’t have a stem cell transplant because either they aren’t well enough, or they don’t have a donor

This treatment is only suitable for a small number of children and young people. It is not used as a treatment outside of clinical trials for other types of cancer in children. 

Only a small number of centres in England can provide this specialist treatment. 

Scotland, Wales and Northern Ireland

Your child might be able to have CAR T-cell therapy if they are in Scotland, Wales and Northern Ireland. However, they have to travel to England to one of the specialist treatment centres for CAR T-cell therapy.

Speak to your child's consultant if you think this treatment might be suitable for your child.
Last reviewed: 
04 Nov 2021
Next review due: 
04 Nov 2024
  • ALLTOGETHER ALLTogether1 – A Treatment study protocol of the ALLTogether Consortium for children and young adults (1-45 years of age) with newly diagnosed acute lymphoblastic leukaemia. Clinical Study Protocol. Master Protocol.
    Mats Heyman and others
    June 2020

  • The EBMT Handbook. Hematopoietic Stem Cell Transplantation and Cellular Therapies
    E Carreras and others
    Springer Open, 2019

  • Oxford Textbook of Cancer in Children (7th Edition)
    H N Caron and others
    Oxford University Press, 2020

  • Tisagenlecleucel for treating relapsed or refractory B-cell acute lymphoblastic leukaemia in people aged up to 25 years
    National Institute for Health and Care Excellence (NICE), December 2018

  • CAR-T Therapy
    NHS website, accessed September 2021

  • 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 with details of the particular issue you are interested in if you need additional references for this information.

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