Stages of treatment
Treatment for acute lymphoblastic leukaemia is usually done in 3 stages.
Stage 1 is remission induction. The aim of remission induction is to kill the leukaemia cells in your bone marrow, restore the balance of cells in your blood, and relieve your symptoms.
Stage 2 is consolidation. This aims to kill any remaining leukaemia cells.
Stage 3 is maintenance. This involves taking regular doses of chemotherapy medicines to stop leukaemia coming back.
The remission induction stage of treatment is done in hospital or at a specialist centre.
You'll probably need regular blood transfusions because your blood will not contain enough healthy blood cells.
You'll also be vulnerable to infection, so it's important you're in a sterile environment where your health can be carefully monitored and any infections can be treated quickly.
Antibiotics may also be given to help prevent infection.
You'll have chemotherapy to kill the leukaemia cells in your bone marrow. The chemotherapy medicine used is called methotrexate.
Although this medicine comes as a tablet, you'll also need it to be given as injections.
To make injections easier, you may have a flexible tube (a central line) put into a vein in your chest, which is used to give you medicines.
You may also have chemotherapy medicine injected into the fluid that surrounds and protects your spine (cerebrospinal fluid) to kill any leukaemia cells that may have spread to your nervous system and brain. This is given in a similar way to a lumbar puncture.
After an injection into your spine you'll have to lie flat for a few hours with your head slightly lower than your feet. You may have a headache or feel sick afterwards.
Methotrexate is also given into a vein (intravenously) in adults with acute lymphoblastic leukaemia after remission induction therapy and before consolidation.
Common side effects of chemotherapy include:
- feeling and being sick
- loss of appetite
- mouth ulcers
- skin rashes
- hair loss
The side effects should get better once treatment has finished.
Find out more about what happens during chemotherapy.
You may also be given steroid (corticosteroid) injections or tablets to help improve the effectiveness of chemotherapy.
If you have a type of leukaemia called Philadelphia chromosome-positive acute lymphoblastic leukaemia (which affects around 20 to 30% of people with acute lymphoblastic leukaemia), you'll also be given a medicine called imatinib.
Imatinib is a targeted therapy which blocks signals in the cancerous cells that cause them to grow and reproduce. This kills the cancerous cells.
Imatinib comes as a tablet. The side effects are usually mild and should improve over time.
- feeling or being sick
- swelling in the face and lower legs
- muscle cramps
- skin rash
Depending on how well you respond to treatment, the remission induction phase can last from 2 weeks to several months.
Sometimes you may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve.
If other treatments do not work, your cancer comes back or you have a certain type of acute lymphoblastic leukaemia, you may be given a different targeted therapy. The 2 alternative medicines used are:
These come as a table and cause similar side effects to imatinib.
Want to know more about targeted therapies?
The aim of consolidation treatment is to ensure that any remaining leukaemia cells are killed.
The consolidation phase involves regular injections of chemotherapy medicine.
This is usually done on an outpatient basis, so you will not have to stay in hospital overnight.
But you may need some short stays in hospital if your symptoms suddenly get worse or you get an infection.
The consolidation phase lasts several months.
The maintenance phase is a further step to help ensure the leukaemia does not come back.
It involves taking regular doses of chemotherapy medicine while having regular check-ups to monitor your treatment.
The maintenance phase can often last for 2 years.
As well as chemotherapy, steroids, and targeted therapies, other treatments are sometimes used.
Radiotherapy is where high doses of controlled radiation are used to kill cancerous cells.
It's usually used to treat acute lymphoblastic leukaemia when:
- acute lymphoblastic leukaemia has spread to the nervous system or brain
- the body needs to be prepared for a bone marrow transplant
Side effects of radiotherapy include:
- hair loss
- feeling sick
These side effects should pass after your course of radiotherapy has finished.
Your skin may be very sensitive to the effects of light for several months after treatment has finished. If this happens, avoid sunbathing or exposure to artificial sunlight, such as sunbeds, for several months.
Many young children treated with radiotherapy will go on to have restricted physical growth during puberty.
A small number of people develop cataracts several years after having radiotherapy.
Cataracts are cloudy patches in the transparent structure at the front of the eye (the lens) that can make your vision blurred or misty.
They can usually be successfully treated using cataract surgery.
Stem cell and bone marrow transplants
A stem cell and bone marrow transplant is an alternative treatment option if you not respond to chemotherapy.
A transplant of bone marrow and stem cells is usually more successful if the donor has the same tissue type as you, so the ideal donor is usually a brother or sister.
Before a transplant can happen, the person receiving the transplant will need to have high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body.
This can put a big strain on the body, so transplants are usually only successful when they're done in:
- children and young people
- older people who are in good health
- when there's a suitable donor, such as a brother or sister
Recent research has shown it's possible for people over the age of 40 to have a reduced-intensity stem cell transplant.
This is where lower than normal doses of chemotherapy and radiotherapy are used before the transplant, which places less strain on the body.
Immunotherapy is a type of treatment where medicines are used to encourage the body's immune system to target and kill cancerous cells.
Immunotherapy may be recommended if you do not respond to other treatments or the cancer comes back after other treatments.
There are 2 immunotherapy medicines used to treat acute lymphoblastic leukaemia:
- inotuzumab ozogamicin
These medicines are given through a drip into a vein.
Side effects of immunotherapy include:
- flu-like symptoms, such as high temperature, chills and muscle aches
- feeling and being sick
Immunotherapy can also make you more vulnerable to infection. Talk to your care team for advice if you suddenly feel very unwell.
In the UK, clinical trials are currently being done to find the best way of treating types of acute leukaemia.
These studies are using new techniques to see how well they work in treating and possibly curing acute leukaemia.
It's important to be aware of new studies so you can choose which treatments to have.
But there's no guarantee the techniques being studied in the clinical trial will be more effective than current treatments.
Your care team will be able to tell you whether there are any clinical trials available in your area and can explain the benefits and risks involved.