Treatment options for acute lymphoblastic leukaemia (ALL)

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

On this page you’ll find information about :

• your treating team
• how your doctor decides which treatment you need
• an overview of treatment for 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 leukaemia you have
• your age, general health and level of fitness
• if you have gene changes (mutations) in the leukaemia cells
• where the leukaemia has spread to

Treatment overview for ALL

You might have treatment for ALL as part of a clinical trial. The main treatment for ALL is chemotherapy. You might also have other treatments for ALL. These might include:

• steroids
• growth factors
• targeted cancer drugs
• stem cell or bone marrow transplant
• immunotherapy including CAR T-cell therapy
• radiotherapy

Supportive treatment

You also need other treatments to support you while you have your leukaemia treatment. Supportive care helps to prevent infections or to help with the side effects of treatment. These include:

• anti sickness medicines
• antibiotics, antifungals and antivirals to help prevent infection
• red blood cell and platelet transfusions
• medicines to protect your kidneys from a condition called tumour lysis syndrome
• fluid through a drip if you are in hospital, they are sometimes needed 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. These phases are called:

• steroid pre phase
• induction
• consolidation
• intensification
• maintenance

The names of the phases of ALL treatment aren't very important. They have been this way for a very long time. But it's good to know what your treatment team might be referring to when they explain your treatment to you.

Doctors work out your treatment based on your type of ALL, age and level of fitness. Your treatment team will explain your treatment plan and each phase to you. At diagnosis its best to focus on the first part of your treatment plan. As the response to how well it has worked will decide what treatment you are going to have next.

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 are often back to work or college. If you have a stem cell or bone marrow 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.

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 

Leukaemia that comes back after treatment is called relapsed leukaemia. Treatment depends on:

• certain features of the leukaemia cells
• how long you were in remission
• your age, general health and level of fitness
• what treatment you had before

Your doctor will discuss all your treatment options with you.

Clinical trials

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