Chemotherapy trials for acute lymphoblastic leukaemia

Most treatment for acute lymphoblastic leukaemia (ALL) is given as part of large national and international clinical trials. These help doctors improve treatments and learn more about the best way to give them.

Clinical trials use drugs and treatments for ALL that are already known to work well, but in different combinations.

The trial you are invited to enter will depend on your age and general fitness. Some current trials available in the UK include:

  • UKALL 2011 – for children and young people aged 1–24.
  • UKALL 14 – for people aged 25–65.
  • UKALL 60 +  – for people aged 60 and over.

The same chemotherapy drugs are used in all three UKALL trials in different combinations. You will also be treated with a combination of these drugs if you have standard treatment outside of a trial. Your doctors and nurses can give you more information on the options available to you.

Clinical trials for ALL

In the UK, most treatment for ALL is given as part of large national and international clinical trials. The trials use drugs and treatments for ALL that are already known to work well, but give them in different combinations. They may also test newer types of drugs alongside current treatments. This helps doctors to improve treatments further and find out more about the best way to give them.

Each trial uses a combination of different chemotherapy drugs.

Depending on your age and general fitness you will usually be invited to enter a clinical trial. Many of the trial names begin with the name ‘UKALL’ which stands for United Kingdom Acute Lymphoblastic Leukaemia. Your doctor will tell you about the UKALL trial which you can enter. The following are some of the current trials available in the UK. There may be other trials available which your doctor will discuss with you.


UKALL 2011

This trial is for children and young people aged 1–24. We have written this information for those aged 16–24. We have separate information on children under the age of 16 as well as more information on ALL in children.

Treatment takes place in five phases. In each phase you will be given a combination of chemotherapy drugs. For some phases you will mainly be treated as an inpatient and for others you will have most treatments as an outpatient.

PhaseAimHow long?Planned time in hospital
InductionTo get you into remission5 weeksBetween 1–4 weeks
IntensificationTo get rid of any remaining leukaemia cells5–9 weeksMainly outpatient
Interim maintenanceTo give you a break from intensive treatment8 weeksOutpatient
Delayed intensificationTo get rid of any leukaemia cells remaining7–8 weeksOutpatient
MaintenanceTo keep leukaemia away long-term2–3 yearsOutpatient


UKALL 14

This trial is for people aged 25–65. You may also be invited to enter this trial if you are aged 19–25 and have the Philadelphia chromosome. Your doctors and nurses will give you full and detailed information about the trial if you agree to enter, but we have outlined it in simple terms here.

Induction

The first phase of treatment is called induction. Its aim is to get you into remission. This phase lasts about eight weeks. You will be in hospital for most of this time.

During induction you will be given a combination of several chemotherapy drugs. After the induction phase of treatment you will have tests to check that you are in remission and to find out what your risk of the leukaemia coming back is.

Following induction, if you are over 40, you will have intensification treatment made up of high dose chemotherapy. This takes about 4 weeks with some of the time spent in hospital.

The next phase of this trial depends on your risk of leukaemia coming back. It also depends on whether you have a brother or sister who can be a stem cell donor (sibling donor) or not.

If you have a sibling donor

If you have a brother or sister (sibling) who is a suitable donor you may have a stem cell transplant.

If you don’t have a sibling donor

If you don’t have a sibling donor your treatment plan will depend on the risk of the leukaemia coming back.

If your doctors think there is a high risk the leukaemia could come back, you may be given a stem cell transplant from an unrelated donor.

Whether you are high risk depends on a number of factors. Some of these include:

  • age
  • the number of white cells in your blood (white cell count) when you were diagnosed
  • whether the leukaemia cells have chromosome changes such as the Philadelphia chromosome
  • the level of minimal residual disease.

If there is a moderate risk (called standard risk) the leukaemia could come back, you will be offered intensification chemotherapy. This is to try to prevent or treat any leukaemia in the brain or spinal cord. This will be followed by further chemotherapy (consolidation) which you can often have as an outpatient. Then finally you will have maintenance treatment as an outpatient with lower doses of chemotherapy.


UKALL 60+

This trial is for people aged 60 and over. You may also be invited to enter this trial if you are 55 and over but are not fit enough to have intensive treatment. Intensive treatment means having lots of treatment, sometimes at high doses.

People in this trial will have many of the same drugs as those in younger age groups. But they may be given them in a standard or low dose depending on how well they are. Most people will have their treatment in the three phases previously mentioned: induction, intensification and maintenance.

UKALL 60 is a type of trial called an observational study. This means that the trial is not looking at a specific treatment plan or particular drug. Instead doctors use existing and current treatments and the researchers make a record of what happens. Once this information is gathered it can help guide researchers to which treatments they need to focus on in future trials for this age group.

Back to Chemotherapy explained

Your feelings

You may experience difficult feelings while having chemotherapy treatment. Talking these over can be helpful.

Where can you have chemotherapy?

You usually have chemotherapy in a chemotherapy day unit or clinic. If your treatment is more complex, you may need to stay in hospital.

Who might I meet?

A team of medical specialists will be involved throughout the course of your chemotherapy treatment.