Treatment options for acute lymphoblastic leukaemia (ALL)

When you are diagnosed with ALL, a team of healthcare professionals decide what treatment options you have.

People with ALL usually start treatment quite quickly after diagnosis. You usually have steroids first for several days followed by chemotherapy. You might have treatment as part of a clinical trial.

This page is about treatment options for adults with ALL. We have separate information about children with ALL.

Your treatment team

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multi disciplinary team (MDT).

Your MDT might include:

• blood cancer specialists called consultant haematologists
• haematology nurse specialists, also called clinical nurse specialists (CNS)
• dietitians
• doctors specialising in reporting bone marrow or lymph node biopsies (haematopathologists)
• doctors specialising in reporting x-rays and scans (radiologists)
• doctors specialising in diagnosing and controlling infection (microbiologists)
• social workers
• symptom control specialists called palliative care doctors and nurses
• pharmacists

Deciding which treatment you need

Your MDT will discuss your treatment, its benefits and the possible side effects with you. Your treatment will depend on:

• the type of ALL you have

• your age, general health and level of fitness

• whether you have gene changes (mutations) in the leukaemia cells

• where the leukaemia has spread to

• whether you are eligible for a clinical trial

• your personal wishes

Treatment overview for ALL

You usually have a combination of treatments for ALL. The main treatment is chemotherapy. You might have treatment as part of a clinical trial.

Treatment options include:

• chemotherapy

• steroids

• growth factors

• targeted cancer drugs

• immunotherapy including CAR T-cell therapy

• stem cell transplant

• radiotherapy

• supportive treatment

Chemotherapy

Chemotherapy uses anti cancer drugs called cytotoxic drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. Your treatment usually includes a combination of different chemotherapy drugs with steroids. This is called a chemotherapy regimen.

Steroids

Steroids are substances made naturally in the body that affect many functions. They can be made artificially and used in cancer treatment as tablets or injections. You usually start steroids as soon as you are diagnosed with ALL.

Growth factors

Growth factors are proteins made in the body. They help cells grow and encourage the bone marrow to produce blood cells. You may have growth factor medicine during chemotherapy or in preparation for your stem cell transplant. They help your bone marrow recover and make more blood cells. You usually have it as an injection just under the skin.

Targeted cancer drugs

Targeted cancer drugs work by targeting the differences that a cancer cell has. There are different types of targeted cancer drugs. If you have Philadelphia positive ALL you might have a targeted cancer drug called imatinib.

Immunotherapy and CAR T-cell therapy

Immunotherapy is treatment that stimulates the body's immune system to fight cancer. You might have immunotherapy with chemotherapy if your leukaemia comes back. CAR T-cell therapy is a new type of immunotherapy. You might have CAR T-cell therapy if your ALL comes back or doesn’t respond to treatment as well as your doctor would like. You may also have immunotherapy as part of a clinical trial.

Stem cell transplant

Having a transplant means destroying as many leukaemia cells as possible and replacing these with healthy stem cells . In ALL, you have the stem cells from someone else (a donor). This is known as an allogeneic transplant or allograft.

Radiotherapy

Radiotherapy is a type of cancer treatment that uses high energy waves similar to x-rays to kill cancer cells.

You might have radiotherapy as part of your preparation for a stem cell transplant. In this situation, you have radiation to the whole body. This is called total body irradiation (TBI).

Some people have radiotherapy if they have leukaemia in their brain and spinal cord (central nervous system). The radiotherapy will be aimed at the brain and spinal cord.

Supportive treatment

You need other treatments and medicines to support you while you are treated for ALL. Supportive care helps to prevent infections and relieve the side effects of treatment. These can include:

• anti sickness medicines

• antibiotics, antifungals and antivirals to help prevent or treat infection

• red blood cell and platelet transfusions

• medicines to protect your kidneys from a condition called tumour lysis syndrome

• fluid through a drip to keep you hydrated

• mouth washes and painkillers to help with the any side effects of ulcers and sores in the mouth

• medicine to stop your periods such as norethisterone

Phases of treatment

Doctors divide treatment for ALL into different phases.

• steroid pre phase

• induction

• consolidation

• intensification

• maintenance

Doctors work out your treatment based on your type of ALL, age and level of fitness. Your team will explain your treatment plan and each phase to you. Which treatment you have for each phase can depend on how well the treatment is working. It might help to focus on one treatment or phase at a time.  

Standard ALL treatment usually takes between 2 to 3 years altogether. The maintenance phase takes up most of this time as it lasts 2 years. During the maintenance phase people often go back to work or college. If you have a stem cell transplant, the treatment time is shorter but more intensive.

Treating ALL that comes back or resists treatment

Sometimes tests still find leukaemia cells in the bone marrow while you’re having treatment. This means the leukaemia isn’t responding to the drugs you’re having. It’s called resistant or refractory leukaemia. Leukaemia that comes back after treatment is called relapsed leukaemia. 

Your doctor may recommend you have:

• more chemotherapy using different drugs 
• a targeted cancer drug
• CAR T-cell therapy
• treatment as part of a clinical trial 

Your doctor will discuss all your treatment options with you.

Clinical trials

You might have treatment for ALL as part of a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.