Treatment for acute lymphoblastic leukaemia (ALL leukemia)
There are different treatments for acute lymphoblastic leukaemia. Treatment usually starts as soon as possible after diagnosis.
The aim of treatment for acute lymphoblastic leukaemia (also called ALL or ALL leukemia) is to get rid of the leukaemia cells as quickly as possible, so your bone marrow can work normally again. This is called remission.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy the leukaemia cells. This is the main treatment for ALL. You will have several different chemotherapy drugs. Most of the drugs will be given into a vein (intravenously). You will take others by mouth as tablets.
At times during treatment you will have chemotherapy given into the fluid around your spine and brain. This is called intrathecal chemotherapy. It may be given to treat or prevent leukaemia in this area of the body.
Tyrosine kinase inhibitors
If tests show you have a type of ALL called Philadelphia positive ALL (Ph+ ALL), your treatment will include a drug called a tyrosine kinase inhibitor (TKI). Imatinib is the most commonly used TKI drug for ALL.
Stem cell transplant
Immunotherapy drugs use the body’s own immune system to recognise and destroy leukaemia cells. This type of treatment is not used very often to treat ALL. A drug called rituximab is sometimes used to treat B-cell ALL if tests show the leukaemia cells have a protein called CD20 on their surface. Drugs called blinatumomab and inotuzumab are sometimes used to treat B-cell ALL that has come back (relapsed) or that has not gone into remission with chemotherapy. Your doctor or specialist nurse can tell you more about these drugs if they are suitable for you.
Treatment usually starts as soon as possible after diagnosis. Most people in the UK have treatment for ALL as part of research called clinical trials. Before you have any treatment, your doctor will explain the different treatments and their side effects. They will also talk to you about things to think about when making treatment decisions.
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Treatment for ALL is usually given in 3 main phases.
- Induction phase – chemotherapy and other drugs are given to get rid of the leukaemia cells in your blood and bone marrow.
- Consolidation or intensification phase – further chemotherapy is given to get rid of any remaining leukaemia cells, particularly in other parts of the body such as the brain or spinal cord. Some people may also have a stem cell transplant.
- Maintenance phase – chemotherapy and other drugs are given to reduce the risk of leukaemia coming back.
Your doctor and nurse will explain your exact treatment plan and what to expect in each phase. You will have some treatment as an inpatient in hospital. This is more likely during the induction and consolidation phases. You may stay in hospital for a few weeks at a time. You may stay in for longer if you need treatment to manage side effects, or if you have a stem cell transplant. Maintenance treatment is often given as tablets, which you can take at home. Sometimes, you will be in hospital to have chemotherapy given into a vein or into the fluid around your brain and spinal cord (called intrathecal chemotherapy).
You will usually have your treatment in a hospital that offers specialist treatments, such as chemotherapy and stem cell transplants. These are usually larger hospitals, so you may have to travel for your treatment and appointments.
Teenagers and young adults
Some hospitals have cancer units for teenagers and young adults. These are sometimes called TYA units. Other hospitals may have a ward or area for teenagers. Not every hospital offers this. You may have to travel further from home to have treatment at one.
Having your treatment in a TYA unit means you can be with other young people. There may be a kitchen you can use or spaces to relax and meet friends. The staff are trained in looking after young people with cancer and understand what you are going through.
You might not be able to go to a hospital that has a TYA unit or you may choose not to. This may mean you are treated on a cancer ward for adults. Overall, your treatment and care will be the same.
Many treatments for acute leukaemia are given into your bloodstream. These are given through a line put into a vein.
During induction treatment, you may have a short thin tube called a cannula. This is put into a vein in the back of your hand or lower arm. Your nurse will place a clear dressing over it to make sure it stays in place. Having a cannula put in can be a bit uncomfortable or painful, but it should not take long and any pain soon gets better. A cannula can stay in place for several days if needed.
By the start of your consolidation treatment, you will have a central line, PICC line or port put in. This type of line can stay in place for several months and you can go home with it. It is used to give treatments into your bloodstream. It can also be used to take blood samples.
Most people get used to having a line or port. Your nurse will explain how to look after your line or port so that it does not get blocked or cause infection. They will arrange any support you need. If you are worried about your line or port, contact your team in the chemotherapy clinic or on the ward.
Leukaemia and treatment for leukaemia can cause symptoms and side effects. Your doctor will monitor these and give you supportive treatment to prevent or manage them. This may include having:
- red blood cells or platelets given into a vein if you have low numbers of these cells – called a blood or platelet transfusion
- drugs to prevent infections if you have low numbers of healthy white blood cells
- drugs to prevent or manage side effects of treatment.
We also have more information about looking after yourself during treatment and while you recover.
Sometimes ALL comes back after a remission. This is called a relapse. If you relapse, it may be possible to have more treatment and get into a second remission. A long-term remission or cure is the aim of the treatment.
Some people will have a further treatment called a stem cell transplant once they are in remission. This can help reduce the risk of relapse in some situations.
Sometimes treatment can control the leukaemia but not cure it. The aim of treatment is to reduce any symptoms and improve quality of life for as long as possible.
Below is a sample of the sources used in our acute lymphoblastic leukaemia (ALL) information. If you would like more information about the sources we use, please contact us at email@example.com
Hoelzer D, et al. Acute lymphoblastic leukaemia: ESMO clinical practice guidelines. Annals of Oncology. 2016. 27 (Supplement 5): v69-v82.
National Institute for Health and Care Excellence. Blood and bone marrow cancer. www.nice.org.uk/guidance/topic/conditions-and-diseases/blood-and-immune-system-conditions/blood-and-bone-marrow-cancers (accessed July 2018).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.
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