Treating acute lymphoblastic leukaemia (ALL)

The medical team will recommend a treatment plan and discuss this with you as soon as the diagnosis has been made, as it is extremely important to start treatment as soon as possible. Treatment plans are tailored to each individual and their type of ALL. The main factors to consider are:

• The patient’s opinion on which treatment(s) they want to receive
• Patient fitness to receive intensive chemotherapy treatment
• Medical opinion on which treatment is most effective to control the disease

Most people will commence steroid treatment whilst their treatment plan is being confirmed. The steroids will immediately start treating the leukaemia whilst the patient is being prepared for chemotherapy.

You will be given various types of chemotherapy to kill the leukaemia cells in your bone marrow. Although some medications may be given as pills, you will need more than one medication given as an infusion. To make things easier and avoid repeated injections, they can all be given via one flexible tube into a vein in your chest called a PICC (Peripherally Inserted Central Catheter) line.

Some chemotherapy medication will also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may be present. This is given using a needle that is placed into your spine, in a similar way to a lumbar puncture.

Side effects that occur following chemotherapy are common:

• Infection – minor and major
• Bleeding and bruising
• Nausea and Vomiting
• Diarrhoea
• Loss of appetite
• Painful mouth and throat
• Fatigue
• Skin rashes
• Hair loss
• Fertility issues – not always permanent and where possible fertility preservation is offered

The side effects should resolve once treatment has finished. Your hair will usually take between three to six months to grow back.

The induction stage of treatment is carried out as an inpatient in UCLH and will last about 4 weeks. At this stage you may be vulnerable to infection, so it is important that you are in an environment where you can be carefully monitored and any infection that you have promptly treated. As chemotherapy temporarily affects the production of normal blood cells you are likely to need regular blood and platelet transfusions.

If you have a type of leukaemia known as Philadelphia chromosome-positive ALL, you will also be given a medicine called imatinib. Imatinib works by blocking the signals in the cancerous cells that cause them to grow and reproduce.

Imatinib is taken orally (as a tablet). The side effects of imatinib are usually mild and should improve over time. They include:

• Nausea and vomiting
• Swelling in the face and lower legs
• Muscle cramps
• Skin rash
• Diarrhoea

Following induction chemotherapy, the medical team will assess the response of your disease by undertaking a bone marrow test and any appropriate scans. This will enable the team to compare the results with the diagnostic tests and decide on the best next course of treatment.

The maintenance phase, which can last for up to two years, is designed to act as further insurance against the possibility of the leukaemia returning. It involves taking regular doses of chemotherapy tablets, and less frequent intravenous and lumbar puncture chemotherapy. The treatment is given as an outpatient and most people can return to work or education during this phase.

Leukaemia can return if residual cancerous cells remain in your body. Therefore the aim of consolidation treatment is to ensure that any remaining leukaemia cells are killed.

Treatment involves receiving regular injections of chemotherapy medication. This is usually done on an outpatient basis, which means you will not have to stay in hospital overnight. However, you may require some short stays in hospital if your symptoms suddenly get worse or if you develop an infection.

The consolidation phase of treatment lasts several months.