Chemotherapy for acute lymphoblastic leukaemia

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy the leukaemia cells. Cytotoxic means toxic to cells. The drugs travel round the body in the bloodstream. They disrupt the way that leukaemia cells grow and divide but they also affect normal cells.

What chemotherapy for ALL involves

When ALL is diagnosed it’s important to start treatment as soon as possible.

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

Some people have the induction phase of chemotherapy followed by a stem cell transplant. They will not have intensification/consolidation or maintenance phases.

  • Induction – the aim is to get you into remission. You have this phase of treatment as an inpatient. You will usually spend a few weeks in hospital. Some people may be able to have part of this phase as an outpatient.
  • Intensification/consolidation – the aim is to get rid of any leukaemia cells that may remain. You will 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 is 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
  • 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.

You’ll have several different chemotherapy drugs in various combinations in each phase of treatment. Chemotherapy drugs can be given in different ways. 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 and help make chemotherapy more effective. You will usually start steroid treatment a few days before chemotherapy.

Tumour Lysis Syndrome

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

Chemotherapy drugs

The following chemotherapy drugs are used to treat ALL. They are used in clinical 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.

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.

Nelarabine is given as a drip (infusion). Your doctor or specialist nurse can give you more information on it.

Chemo was definitely a shock to the system. For the first few rounds I was absolutely fine but then I did get sick.


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Chemotherapy trials for ALL

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