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The main treatment for acute lymphoblastic leukaemia (ALL) is chemotherapy| (chemo). This means having anti-cancer drugs to destroy the leukaemia cells. You’ll also have drugs called steroids, which help the chemo to work.
The treatment for ALL is pretty intensive at times and can cause unpleasant side effects. But you'll be in hospital when you’re most likely to feel unwell and the staff will be able to help if things get tough.
ALL is treated in three phases:
You usually start chemo pretty quickly after finding out that you have ALL.
You'll be in hospital for your treatment to begin with. Teenagers are often treated in wards especially for young people with cancer.
I wouldn't want to go through it again and anyone who is going through it, then I know how you feel. It's very difficult but there is a light at the end of the tunnel because I've got through it and you can get through it as well.
You’ll be given chemo as tablets, by injection and into your bloodstream (intravenously). You’ll also be given chemo into the fluid inside the spinal cord to make sure the leukaemia cells can’t hide there. This is called central nervous system (CNS) therapy
You’ll have a ‘line’ put in to one of your main veins to make it easier for you to have intravenous treatment. Your nurses and doctors can also use the line to take blood samples for blood tests. There are different kinds of lines. You might have a central line (Hickman® or Groshong®) an implantable port (portacath), or a PICC line.
Having chemo can be hard, but the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And you’ll be given medicines to help you feel less sick and antibiotics to help prevent infections.
There will probably be times when you feel rough and other times when you’ll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings.
Being in hospital for long periods can be frustrating, especially when you miss out on stuff happening at school or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you.
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We have more information about chemotherapy| that has been written for people of all ages, not just teens and young adults. You can also find out more about the individual chemotherapy drugs|.
The first phase of your treatment is about getting rid of the leukaemia. You’ll be given chemo to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow.
This type of treatment involves:
You need to stay in hospital during this phase of your treatment so the doctors can check how things are going.
Treatment to get you into remission takes about five weeks, sometimes a bit longer. Being in hospital that long can be really difficult at times. If you would like more information on how to cope, have a look in our deal with it section.
Drugs you may be given include:
Chemo can cause side effects. For more information about these, have a look in the treatment section for each drug.
Chemo given as tablets or into the blood can reach most places in your body but isn’t good at getting into the brain or spinal cord (called the central nervous system or CNS). So you’ll be given treatment into the fluid that goes around the CNS to target any leukaemia cells that might be hiding there. This is called CNS therapy.
CNS therapy is given during remission induction treatment (to get rid of the leukaemia) and continues right until the end of maintenance therapy.
Chemo is given into the fluid, called cerebrospinal fluid or CSF, around your spinal cord. Drug treatment given into the CSF is called intrathecal therapy.
It’s a bit like having a lumbar puncture but with chemo added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then they inject chemo into the CSF. The CSF will carry the chemo around your CNS so it can reach any leukaemia cells that might be there.
The chemo drug that’s used for CNS therapy is called methotrexate.
Some people also have radiotherapy (x-ray treatment) to their brain but this isn’t common. It’s most likely to be given if there were leukaemia cells in your spinal fluid when you were first diagnosed
Most people don’t have side effects after having intrathecal methotrexate. But occasionally it can cause headaches, dizziness, tiredness, or blurry vision for a few hours.
This treatment is called consolidation and delayed intensification therapy. When you’re in remission, it means the doctors can’t see any leukaemia cells in your blood or bone marrow samples when they check them under the microscope. But there may still be leukaemia cells hiding in your body, so further treatment is needed to get rid of these cells.
You’ll be given different types of chemo drugs so the leukaemia cells don't have a chance to get used to them (called drug resistance).
This phase of treatment takes about 5-6 months. Most of the treatment can be given as an outpatient but you might need to stay in hospital for some parts of it.
Chemo does cause side effects. There is information about the specific ones in the chemotherapy section.
This treatment is given to prevent the leukaemia from returning (known as relapse). The chemo is given in low doses. You have it as an outpatient so you can keep doing all your normal, everyday activities when you’re having maintenance therapy.
Maintenance therapy is given in 12 week cycles.
You’ll have:
You’ll need about two years of maintenance therapy, longer if you’re a boy. This is because it takes a bit longer in boys to get rid of any remaining leukaemia cells. At the moment boys have just over three years of treatment and girls have just over two years.
During this time you'll have regular check-ups - usually every week or two - in case drug doses need to be adjusted and to make sure you're okay. Very often, things like blood tests can be done at your GP's surgery or at home by a district nurse.
We also have more info about:
|If you're looking for information about ALL in people of all ages, please see our general ALL| section.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.
Bengu talks about losing her hair when she had treatment for ALL.