Chemotherapy for acute lymphoblastic leukaemia (ALL)
What is chemotherapy?
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy or damage leukaemia cells. These drugs affect with the way leukaemia cells grow and divide.
About chemotherapy for acute lymphoblastic leukaemia (ALL)
Chemotherapy is the main treatment for acute lymphoblastic leukaemia (also called ALL or ALL leukemia). It is usually given in 3 main phases and may take up to 3 years. You have most of the drugs through a line into a vein (intravenously). You take others by mouth as tablets.
You will also have chemotherapy into the fluid around your spine and brain. This is called intrathecal chemotherapy.
Phases of chemotherapy for ALL
The 3 main phases are:
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Induction treatment
The aim of induction treatment is to quickly get rid of the leukaemia cells in your blood and bone marrow. This will allow your bone marrow to work normally again. This is called remission.
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Consolidation treatment
This phase of treatment is to get rid of any remaining leukaemia cells, particularly in areas such as the brain or spinal cord.
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Maintenance treatment
The aim of maintenance treatment is to prevent the leukaemia coming back and to keep you in remission.
Depending on the type of ALL you have, you may have a targeted therapy drug or an immunotherapy drug along with chemotherapy.
Some people go on to have an allogeneic (donor) bone marrow transplant as their best chance of a cure. This is more common if you have Ph+ ALL.
If you have other health problems, you may have lower doses of chemotherapy and other drugs to control ALL for as long as possible. This is called less intensive treatment. It has less risk of serious side effects and may be easier to cope with than high doses of treatment. You may be able to have some treatments as an outpatient.
Induction treatment
This is also called induction phase or induction therapy. You usually need to stay in hospital to have your first chemotherapy treatment. You may also need to stay for a few weeks after until your blood cells recover. You will need a lot of support from nursing and medical staff. They will monitor you closely for side effects, such as infection.
You may need blood or platelet transfusions because your blood cell count will be low for a few weeks. You blood cell count will tell doctors how many red blood cells, platelets and white blood cells you have. You may also need antibiotic and antiviral drugs to prevent or treat infection. This is called supportive therapy.
You may need 1 to 2 cycles of chemotherapy. You usually have a combination of 2 or 3 different drugs. Induction chemotherapy may include the following drugs:
- a steroid (prednisolone or dexamethasone), which everyone will have
- cyclophosphamide
- vincristine
- doxorubicin, daunorubicin or idarubicin
- asparaginase
- methotrexate
- rituximab, a targeted therapy drug, if you have B cell ALL.
Testing for remission
After chemotherapy, your bone marrow and blood cells start to recover. You will have a bone marrow biopsy and blood tests to check if you are in remission or not. If tests show very small numbers of leukaemia cells (minimal residual disease) or none, your doctor will say you are in remission.
Consolidation treatment
This phase of your treatment is to get rid of any remaining leukaemia cells, particularly in areas such as the brain or spinal cord. You will have more intensive chemotherapy in hospital. But you can also have some treatments as a day patient. As with induction, you will need a lot of supportive care.
The drugs used generally include the same as those used during induction. Some other drugs that may also be used include:
Some people may go on to have a stem cell transplant from a donor after 2 or more cycles of chemotherapy. This depends on:
- the risk of ALL coming back
- how you are likely to cope with this treatment.
You are more likely to need a donor stem cell transplant if tests show certain genetic changes inside the leukaemia cells, such as Ph+ ALL.
Chemotherapy into the spine
You will also have chemotherapy into the fluid around your spine and brain (cerebrospinal fluid). This is called intrathecal chemotherapy. You have it to prevent leukaemia cells from spreading to the spine or brain (central nervous system) or to treat any leukaemia cells that may be there.
It is done using a lumbar puncture. A doctor or nurse injects a small amount of chemotherapy through a thin needle into your back. You will have this done at different times during treatment for ALL.
The most common chemotherapy drugs used are:
You will also have a steroid drug into the spine along with the chemotherapy drugs.
Maintenance treatment
Unless you have a donor stem cell transplant, you will have maintenance treatment after consolidation treatment. The aim is to prevent the leukaemia coming back and to keep you in remission. You have it for up to 2 to 3 years as an outpatient.
The most common chemotherapy combination for maintenance treatment for ALL is methotrexate and mercaptopurine. You take these as tablets.
You may also have vincristine into a vein and a steroid called prednisolone.
Side effects of chemotherapy for acute lymphoblastic leukaemia (ALL)
Chemotherapy can cause side effects. Your doctor, nurse or pharmacist will explain what to expect. This depends on the intensity of your treatment and the drugs you have. Different drugs cause different side effects. They will explain how side effects can be controlled or managed. They will also talk to you about the risk of possible late effects.
Your doctors and nurses will monitor you carefully. It is important to tell them about any side effects you have.
We have more information about the side effects of chemotherapy.
About our information
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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.
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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.
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