Phases of treatment
Chemotherapy is the main active treatment for ALL. You’ll be offered a combination of chemotherapy drugs in line with your treatment plan (your healthcare team may call this a protocol or regimen).
Your treatment will be divided into three phases, or ‘blocks’. This section gives an overview of the different phases of treatment.
Your healthcare team will explain to you in detail which drugs you’ll have and when during each phase. Your doctors may be able to give you a chart with this information on too.
> Find out more information on clinical trials
Phase 1: remission induction
The aim of this first phase of treatment is to get you into remission. This involves using several chemotherapy drugs in combination. The goal is to clear the cancer cells completely from your bone marrow and blood. This works for about nine in ten people.
The length of this treatment stage depends on your individual situation. It usually lasts between three weeks and two months.
Because there’s a risk of infection or bleeding, you’re likely to spend all, or most, of this stage in hospital, with your doctors and nurses close by.
Philadelphia positive ALL
If you have this type of ALL, your treatment will be quite different. Doctors use drugs called tyrosine kinase inhibitors (or TKI) to treat it. A drug called imatinib is one example of a TKI. These drugs target the abnormal protein produced by the cancer cells. When combined with standard chemotherapy, these drugs can greatly increase the chance of a cure for people with this kind of ALL.
Around this time, you may also have what’s called intrathecal chemotherapy to give extra protection to your brain and spinal cord. Chemotherapy drugs will be injected into the cerebrospinal fluid (or CSF) around your spine to try and prevent leukaemia cells from entering the fluid. This procedure is the same as a lumbar puncture. After the standard lumbar puncture, and after fluid has been removed, the drugs are carefully introduced.
Testing for remission
When your initial chemotherapy is finished, doctors will look at samples of your blood and bone marrow under a microscope. If they can’t see any leukaemia cells, this means you’re in remission.
Minimal residual disease tests
Increasingly, minimal residual tests (MRD tests) are being used to test for remission in ALL, particularly within clinical trials.
When your doctors look at blood cells through a microscope, the lowest number of leukaemia cells they can detect is about one leukaemia cell in 20 normal cells. The MRD test is much more sensitive and can detect leukaemia cells at levels as low as one leukaemia cell in 100,000 normal cells.
Phase 2: consolidation
This phase is also sometimes called post-induction or post-remission therapy.
It’s possible that some leukaemia cells could still remain after your initial chemotherapy, even if doctors can’t see any under the microscope. So when the induction phase is finished, you’ll have further chemotherapy to clear any leukaemia cells that might remain in your blood and bone marrow.
You might have the same chemotherapy drugs as in the remission induction phase, with other drugs added. The drugs might be changed around so the leukaemia cells don’t become resistant to them.
This stage usually lasts for several months. For most of this time you may be able to stay at home, only visiting hospital for treatment or check-ups (this is known as outpatient treatment). If you have an infection or become ill at any stage during your treatment, you may need to return to hospital for a while.
Stem cell transplant
Some people may be offered a stem cell transplant (also called a bone marrow transplant) during this phase.
Transplants can make you feel very unwell and can bring complications, so doctors would look at a number of factors before offering you one, including your age and general health, and how well you responded to your initial treatment.
A transplant aims to give you healthy stem cells, which then produce normal blood cells. There are two types of stem cell transplant:
- allogeneic or allograft – this uses stem cells from another person (a donor)
- autologous or autograft – this uses your own stem cells but is rarely used for ALL.
> For more information on stem cell transplants, download or order our booklet The seven steps: blood stem cell and bone marrow transplants
Phase 3: maintenance
Maintenance therapy aims to prevent relapse and usually involves low doses of chemotherapy and steroids. The maintenance phase is really important because without it, there’s a higher chance that the ALL could come back, even if you seem to be in full remission. We don’t know why this happens, but we do know that having maintenance therapy gives much better results in the long term.
This stage usually takes about two years. Unless you get an infection or have a relapse, you shouldn’t need to stay in hospital and most people on maintenance therapy can go back to work or college.