Chemotherapy for acute lymphoblastic leukaemia

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy the leukaemia cells. The drugs travel round the body in the bloodstream.

For people who have just been diagnosed with acute lymphoblastic leukaemia (ALL), it’s important to start treatment as soon as possible.

Most treatment for ALL is given as part of large national and international clinical trials.

Chemotherapy drugs

The following chemotherapy drugs are used to treat ALL. They are used in the three UKALL trials in different combinations. You will also be treated with a combination of them if you have standard treatment outside of a trial. Your doctors and nurses can give you more information.

We have more information about these drugs:

Another chemotherapy drug, nelarabine (Atriance®), is sometimes used to treat T-cell ALL. It can be given as part of a clinical trial or if leukaemia has come back after treatment.

What chemotherapy for ALL involves

Treatment is given in three main phases and can take up to 2–3 years to complete.

  • Induction – the aim is to get you into remission (where no leukaemia cells can be found). You have this phase of treatment as an inpatient. You will usually spend a few weeks in hospital.
  • Intensification/consolidation – the aim is to get rid of any leukaemia cells that may remain but can’t be seen. You’ll have some treatment as an inpatient but most as an outpatient.
  • Maintenance – the aim is to reduce the risk of leukaemia coming back. You have treatment as an outpatient as it’s mostly given as tablets. You will also have chemotherapy injections or lumbar punctures every few weeks.

Throughout these phases of your treatment you’ll have regular tests, including blood tests, lumbar punctures, bone marrow biopsies and PCR tests for minimal residual disease. Your doctor will use the results of these tests to plan the next phase or make changes to your treatment if needed.

Chemotherapy can be given in different ways.  You’ll have several different chemotherapy drugs in various combinations in each phase of treatment. Some drugs are given into a vein (intravenously) and others are given as a tablet. Some chemotherapy drugs are given into the fluid around the spine. This is called intrathecal chemotherapy

Steroids are nearly always given as part of treatment for ALL. They kill leukaemia cells, help make chemotherapy more effective and reduce some of its side effects. You will usually start steroid treatment a few days before chemotherapy. We have more information about steroids for ALL.

Chemotherapy drugs are able to get rid of large numbers of leukaemia cells quite quickly. As this happens, your body makes large amounts of a waste chemical called uric acid. This is called tumour lysis. Uric acid can damage the kidneys. To help protect the kidneys you will be given a tablet called allopurinol or a drip (infusion) called rasburicase. 

Back to Chemotherapy explained

Chemotherapy trials for ALL

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

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.