Treatment for acute lymphoblastic leukaemia (ALL leukemia)

How acute lymphoblastic leukaemia (ALL) is treated

The aim of treatment for acute lymphoblastic leukaemia (also called ALL or ALL leukemia) is to get rid of the leukaemia cells as quickly as possible, so your bone marrow can work normally again. This is called remission.

Treatment options include:

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy the cancer cells. This is the main treatment for ALL. You will have several different chemotherapy drugs. Most of the drugs will be given into a vein (intravenously). You will take others by mouth as tablets.
Intrathecal chemotherapy

At times during treatment you will have chemotherapy given into the fluid around your spine and brain (cerebrospinal fluid). This is called intrathecal chemotherapy. It may be given to treat or prevent leukaemia in this area of the body.
Steroids
You almost always have steroids during treatment for ALL. You usually start having steroids a few days before you start chemotherapy. Steroids can:

destroy leukaemia cells

make chemotherapy more effective

reduce allergic reactions caused by some chemotherapy drugs

prevent side effects such as feeling sick (nausea).

Steroids can be given into a vein or as tablets. Prednisolone and dexamethasone are 2 steroids often used to treat ALL.
Targeted and Immunotherapy drugs

If tests show you have a type of ALL called Philadelphia positive ALL (Ph+ ALL), your treatment will include a type of targeted therapy drug called a tyrosine kinase inhibitor (TKI). Imatinib is the most commonly used TKI drug for ALL.

Immunotherapy drugs use the body’s own immune system to recognise and destroy leukaemia cells. A drug called rituximab is sometimes used to treat B-cell ALL if tests show the leukaemia cells have a protein called CD20 on their surface.
Stem cell transplant

A donor stem cell transplant is an intensive treatment that may increase the chances of curing ALL or keep it in remission for longer. This treatment is not suitable or needed for everyone.If you have other health problems, your doctor may advise having less intensive treatment. This has a lower risk of serious side effects and may be easier to cope with than high doses of treatment. The aim of less intensive treatment is to control the leukaemia for as long as possible.

If there is a suitable clinical trial. available, your doctor will talk with you about it. If not, you have the standard ALL treatment. The standard treatment is based on the latest clinical trial results for ALL in the UK.

We understand that having treatment can be a difficult time for people. We're here to support you. If you want to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our acute lymphoblastic leukaemia (ALL) forum to talk with people who have been affected by acute lymphoblastic leukaemia (ALL), share your experience, and ask an expert your questions.

Phases of treatment

Treatment for ALL is usually given in 3 main phases.

Induction phase – chemotherapy and other drugs are given to get rid of the leukaemia cells in your blood and bone marrow.
consolidation (or intensification) treatment – to get rid of any remaining leukaemia cells in areas such as the brain or spinal cord
Maintenance phase – to reduce the risk of leukaemia coming back. This is also called maintenance therapy.

You have some treatment as an inpatient in hospital, usually during induction. You may have to stay in hospital for a few weeks at a time. This may be longer depending on your side effects. If you have a stem cell transplant, you will need to stay in hospital for several weeks.

You usually have maintenance treatment as tablets. You take these at home. This is the longest phase of your treatment.

Your doctor and nurse will talk to you about your treatment plan and what to expect.

Having tests during treatment

During treatment, your doctors and nurses will take blood, bone marrow and lumbar puncture samples to check for leukaemia cells. The results of these tests help doctors:

find out how well your treatment is working
see whether the leukaemia is more likely to come back
decide what treatment you may need next to give you the best chance of a cure.

If your tests show very small numbers of leukaemia cells, or none, the doctor will say you are in remission.

Sometimes very small numbers of leukaemia cells are still found after chemotherapy. This is called minimal residual disease (MRD). This can affect the treatment you need to have.

Where treatment is given?

You usually have your treatment in a hospital that offers specialist treatments such as chemotherapy and stem cell transplants. These are usually larger hospitals, so you may have to travel for your treatment and appointments.

Teenagers and young adults

Some hospitals have cancer units for teenagers and young adults (TYAs). These are sometimes called TYA units. Not every hospital has these, but you may be offered the option. You may have to travel further from home to have treatment at one of these units. Other hospitals may have a specific ward or area for TYAs.

Having your treatment in a TYA unit means you can be with other young people. There may be a kitchen you can use or spaces to relax and meet friends. The staff are trained in looking after young people with cancer.

You might not be able to go to a hospital that has a TYA unit, or you may choose not to. This may mean you are treated on a cancer ward for adults. But you will still be referred to the specialised TYA team and offered psychological and social support from them. Your leukaemia treatment will be the same wherever you have it.

Supportive care

Leukaemia and its treatment cause side effects, such as low levels of blood cells. These side effects can be serious. Your doctor healthcare team will monitor them and give you supportive treatment to prevent or manage them. This may include having:

red blood cells or platelets given into a vein – called a blood or platelet transfusion
drugs to prevent infections
rugs to prevent or manage side effects of treatment.

We also have more information about looking after yourself during treatment and while you recover.

Treating ALL that comes back

Sometimes ALL comes back after a remission. This is called a relapse. If you relapse, it may be possible to have more treatment with chemotherapy, targeted or immunotherapy drugs, or CART-T cell therapy. The aim is to get a second remission. Some people go on to have a stem cell transplant when they are in remission again.

Some people will have a further treatment called a stem cell transplant once they are in remission. This can help reduce the risk of relapse in some situations.

Sometimes treatment can control the leukaemia but not cure it. The aim of treatment is to reduce any symptoms and improve quality of life for as long as possible.

Making treatment decisions

Treatment for ALL usually has to start quickly. If you do not feel ready to make a decision, ask your doctor how long you can have to think about it.

Your doctor needs to make sure you have all the information you need to make your decision. You need to understand all your treatment options and what will happen if you do not have the treatment.

It can help to talk to your family or friends. You and your doctor can then decide together on the best treatment plan for you.

Benefits and disadvantages of treatment

Treatment for leukaemia has possible benefits but also possible risks.

Treatment that aims to cure the leukaemia may involve some disadvantages such as:

longer stays in hospital – usually for several weeks at a time
short-term side effects that may need treatment
a risk of permanent side effects such as infertility.

Many people decide to have this treatment because the chance of curing the leukaemia outweighs these disadvantages. But there is still a risk the leukaemia may not be cured.

Some people will have treatment that aims to control the leukaemia rather than cure it. This means lower doses of chemotherapy and a lower risk of side effects. It may also mean less time in hospital. This means it may be more suitable for people who:

are not fit enough to cope with more intensive treatment
do not want the risks of more intensive treatment.

But with this treatment, the leukaemia is less likely to go into remission or stay in remission.

Always talk to your doctor or nurse about any concerns you have, so they can give you the best advice.

We have more information about making treatment decisions.

About our information

References

Below is a sample of the sources used in our acute lymphoblastic leukaemia (ALL) information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

NICE (National Institute for Health and Care Excellence). Blood and bone marrow cancers. Available from https://pathways.nice.org.uk/pathways/blood-and-bone-marrow-cancers [accessed August 2021].

Phelan K and Advani A. Novel therapies in acute lymphoblastic leukemia. Current Hematologic Malignancy Reports. 2018.

Hoelzer D, et al. Acute lymphoblastic leukaemia: ESMO clinical practice guidelines. Annals of Oncology. 2016. 27 (Supplement 5): v69-v82.

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

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