Treatment overview for acute lymphoblastic leukaemia
The aim of treatment for ALL is to destroy 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. Further treatment, called consolidation, may be given to stop the leukaemia coming back. This is followed by more treatment known as maintenance that is given to prolong the remission for as long as possible.
For some, remission lasts indefinitely and the person is said to be cured. If the ALL comes back (relapses) after treatment, it can often be treated again and a second remission may be possible.
Multidisciplinary team (MDT)
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Your treatment will be planned by a team of doctors and other staff at your hospital, known as a multidisciplinary team (MDT). The team normally includes:
one or more haematologists who will diagnose the leukaemia in collaboration with specialist laboratory scientists, and who are in charge of your care
specialist nurses who give information and support
a clinical oncologist - a doctor who specialises in radiotherapy and chemotherapy.
It may also include other healthcare professionals, 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 chromosomal abnormalities within the leukaemia cells
your age and general health.
In the UK, treatment for ALL is given according to guidelines which have been agreed by specialists and are based on the results of trials and research. You may be asked to take part in a trial of a new and possibly better treatment.
Chemotherapy (drug treatment) is the main type of treatment given for ALL. It is carried in the bloodstream to nearly all parts of the body, but doesn’t reach the brain and spinal cord.
The brain and spinal cord are known as the central nervous system (CNS). Additional treatment is needed to prevent the leukaemia affecting the CNS; this is known as CNS-directed therapy. It involves giving chemotherapy into the fluid around the brain and spinal cord, which, in some cases, may be combined with radiotherapy to the brain.
The treatment of ALL may cause temporary or permanent infertility. Before the treatment starts you doctor and nurses will discuss this with you, along with some of the things that can be done to help preserve your fertility. We have more information about how treatement for ALL may affect your fertility.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other possible treatments that may be available.
If you don’t understand what you have been told, let the staff know straight away so that they can explain again. Treatments for leukaemia can be complex, so it is common for people to need further explanations.It’s a good idea to have a relative or friend with you when thetreatment is explained, to help you remember the discussion.
You may also find it useful to write down a list of questions before you go to your appointment.
People often feel that the hospital staff are too busy to answer their questions, but it’s important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.
You can always ask for more time if you feel you can’t make a decision when it’s first explained to you.
You are also free to choose not to have the treatment. The staff can explain what will happen if you don’t have it. They can also explain what support may be available if this is your choice. The medical staff will need to 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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Many people are frightened by the idea of cancer treatment, particularly because of the side effects that can occur. However, these can usually be controlled with medicines.
Treatment can be given for different reasons, and the aims and possible benefits will vary depending upon the individual situation.
If the aim of your treatment is to achieve a remission and cure for your leukaemia, deciding whether to have the treatment may not be difficult.
However, if a cure is not possible and the treatment is being given to control the leukaemia for a period of time, it may be more difficult to decide whether to go ahead. Making decisions about treatment in these circumstances is always difficult, and you may need to discuss this issue in detail with your doctor. If you choose not to have treatment, you can still be given supportive (palliative) care, with medicines to control any symptoms.
If you want to stop your treatment, it’s important to tell a doctor or the nurse in charge. They can discuss your decision with you and offer you the best advice. They will also make a record of your decision in your medical notes.
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.
However, getting a second opinion can take some time to arrange, and treatment for ALL usually needs to be started as soon as possible. This means that there may not be enough time to arrange a second opinion.
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.