Treatment overview for acute lymphoblastic leukaemia
The main treatment for ALL is chemotherapy. Some people may also have radiotherapy, targeted therapies, or a stem cell transplant. This will depend on the type of ALL you have and how well treatment is working.
The aim of treatment for ALL is to get rid of the leukaemia cells and allow the bone marrow to work normally again. When there is no sign of the leukaemia and the marrow is working normally this is called remission. With treatment, more than 9 out of 10 adults (90%) with ALL will go into remission.
Steroids before treatment
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While doctors are gathering test results to get more information on your leukaemia you will usually be started on steroids
. These will start getting rid of leukaemia cells while a treatment plan is made. Usually this only takes a few days .
The first phase of chemotherapy called induction is given to get you into remission. Further treatment, called intensification, is given to stop the leukaemia coming back. You then have maintenance treatment to keep the leukaemia away long-term.
are drugs designed to identify and attack cancer cells, while doing as little damage as possible to normal cells. They work by ‘targeting’ specific proteins on or in the leukaemia cells. If you have Philadelphia positive ALL (Ph+ALL) you will usually be treated with a targeted therapy tablet called imatinib (Glivec ®) as well as with chemotherapy. This targets the effects of the Philadelphia chromosome
Radiotherapy is the use of high-energy rays, usually x-rays, to treat disease. It works by destroying leukaemia cells in the area that’s treated .
Some people may need a donor stem cell transplant. This is where stem cells from someone else (a donor) are given to you to treat the leukaemia.
Treatment for ALL usually takes about 2–3 years to complete. This may sound like a long time, but usually most of the treatment can be given as an outpatient.
If the ALL comes back (relapses) after treatment, it can often be treated again and a second remission may be possible. When remission lasts indefinitely the person is said to be cured.
Treatment for ALL may cause temporary or permanent infertility. Before your treatment starts your doctor and nurses will discuss this with you. They will explain what may be done to help preserve your fertility.
Where treatment is given
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You will usually have your treatment in a cancer centre. These centres give specialist treatments such as chemotherapy, radiotherapy and stem cell transplants. They are usually based at larger hospitals so you may have to travel to have your treatment and see your haematologist.
Teenagers and young adults
Some hospitals have specially-designed teenage and young adult cancer units (sometimes called TYA units). Other hospitals may have special wards or areas for you if you’re a teenager with cancer. There may be computer games, DVDs and music to help you feel more at home. You may have access to a computer so that you can do some of your school or college work if you feel well enough. There may also be education specialists who can stay in touch with your school or college and support your learning needs while you’re having treatment.
In some hospitals there isn’t a special ward for teenagers with cancer, so you are treated on an adult cancer ward. The staff on the adult cancer wards will still be able to look after your needs, although the facilities may not be the same as those on a unit specially designed for teenagers.
Planning your treatment
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Your treatment will be planned by a team of specialists who will meet to discuss and agree on the plan of treatment they feel is best for you.
This multidisciplinary team normally includes:
one or more haematologists – doctors who specialise in diagnosing and treating blood disorders
specialist nurses, who give information and support
pathologists, who advise on the type and extent of the leukaemia as well as any chromosome changes.
The team may also include other healthcare staff, such as social workers, dietitians, counsellors and physiotherapists.
When planning your treatment, the team will consider a number of factors, including:
the type of ALL you have
any chromosome changes in the leukaemia cells
your age and general health.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent.
Before you are asked to sign the form you should be given full information about:
the type and extent of the treatment
its benefits and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Most leukaemia treatments are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
The benefits and disadvantages of treatment
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The possible benefits of treatment vary depending on each individual situation.
Many people will be offered intensive chemotherapy. This means chemotherapy drugs given at full dose. Intensive chemotherapy aims to cure the leukaemia and involves spending long periods of time in hospital – often several weeks. You are likely to have side effects, but most of these are temporary and can usually be controlled with medicines. However, some effects, such as infertility, may be permanent. For some people intensive chemotherapy will cure the leukaemia, but others may not respond to the treatment. This means that some people may experience the difficult side effects of treatment without any of the benefits.
Some people may not be fit enough to have intensive treatment and some people may choose not to have it. Instead, they may have lower doses of chemotherapy to control the leukaemia rather than to get rid of it completely. This treatment can often be given as an outpatient, so less time is spent in hospital. The chances of the leukaemia going into remission and staying in remission are lower with this treatment.
Some people choose not to have treatment to try to cure or control the leukaemia. In this situation, you can still be given treatments to help control your symptoms. These may include short courses of chemotherapy or steroids. This is called supportive or palliative care.
Your haematologist is the best person to discuss your treatment choices with. Your specialist nurse can also talk over the possible benefits and side effects of treatment with you.
Your multidisciplinary team uses national treatment guidelines to decide on the most suitable treatment for you. Even so, you may want to have another medical opinion. If you feel it would be helpful, you can ask either your specialist or your GP to refer you to another specialist for a second opinion.
I was told what kind of cancer I had and that treatment needed to commence that day. I was mentally unprepared and asked if I could start the treatment the next day to give me time to tell my family.
Getting a second opinion can take some time to arrange, and treatment for ALL usually needs to be started as soon as possible. So you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to take a relative or friend with you. You may want to have a list of questions ready, so that you can make sure your concerns are covered during the discussion.
David Plume explains the benefits and disadvantages of getting a second opinion about your treatment.