Treatment for acute lymphoblastic leukaemia usually begins a few days after diagnosis as it's an aggressive condition that develops rapidly.
Stages of treatment
Treatment for acute lymphoblastic leukaemia is carried out in stages:
- induction – the aim of the initial stage of treatment is to kill the leukaemia cells in your bone marrow, restore the balance of cells in your blood and resolve any symptoms you may have
- consolidation – this stage aims to kill any remaining leukaemia cells in your central nervous system
- maintenance – the final stage involves taking regular doses of chemotherapy tablets to prevent the leukaemia returning
Maintenance only seems to be effective in treating acute lymphoblastic leukaemia; it's not usually used in the treatment of acute myeloid leukaemia.
The induction stage of treatment is carried out in hospital or in a specialist centre. This is because you will probably need to have regular blood transfusions as it's likely that your blood will not contain enough healthy blood cells.
You will also be vulnerable to infection, so it is important that you are in a sterile environment where your health can be carefully monitored and any infection that you have can be promptly treated. You may also be prescribed antibiotics to help prevent further infection.
You will be given 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 injection. 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 central line).
Some chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. 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. They can include:
- loss of appetite
- mouth ulcers
- skin rashes
- hair loss
The side effects should resolve once treatment has finished. Your hair will usually take between three to six months to grow back.
You may also be given corticosteroid injections or tablets to help improve the effectiveness of chemotherapy.
If you have a type of leukaemia known as Philadelphia chromosome-positive acute lymphoblastic leukaemia, 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. This kills the cancerous cells.
Imatinib is taken orally (as a tablet). The side effects of imatinib are usually mild and should improve over time. They include:
- swelling in the face and lower legs
- muscle cramps
Depending on how well you respond to treatment, the induction phase can last from two weeks to several months. In some cases, you or your child may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve.
Leukaemia can return if just one cancerous cell remains 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.
The maintenance phase is designed to act as further insurance against the possibility of the leukaemia returning. It involves taking regular doses of chemotherapy tablets while undergoing regular check-ups to monitor how effective your treatment is proving.
The maintenance phase can often last for two years.
As well as chemotherapy and imatinib, other treatments are used in some circumstances. These are described below.
Dasatinib is a new type of medication used to treat Philadelphia chromosome-positive acute lymphoblastic leukaemia, when all other treatments have proved unsuccessful.
Dasatinib blocks a protein called tyrosine kinase that helps stimulate the growth of cancer cells.
Dasatinib cannot cure acute leukaemia but it can slow its growth, helping to relieve symptoms and prolong life.
The National Institute for Health and Care Excellence (NICE) has not yet made a decision about whether the NHS should provide treatment with dasatinib for people with acute lymphoblastic leukaemia. This means it will be at the discretion of your local clinical commissioning group as to whether you will be offered the drug.
Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are two main reasons why radiotherapy is usually used to treat acute leukaemia:
- to sometimes treat advanced cases of acute lymphoblastic leukaemia that have spread to the nervous system or brain
- to prepare the body for a bone marrow transplant (see below)
Side effects of both types of radiotherapy include:
The side effects should pass once your course of radiotherapy has been completed. However, your skin may be very sensitive to the effects of light for several months after the treatment has finished. If this is the case, avoid sunbathing or exposure to sources of artificial light, such as sunbeds, for several months.
Many younger children treated with radiotherapy will go on to have restricted physical growth during puberty.
A small number of people develop cataracts several years after radiotherapy. Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make your vision blurred or misty. Cataracts can usually be successfully treated using surgery.
Read more about cataracts
Bone marrow and stem cell transplants
If you or your child do not respond to chemotherapy, a possible alternative treatment option is bone marrow or stem cell transplantation.
Transplantations are more successful if the donor has the same tissue type as you, so the ideal donor is usually a brother or sister.
Before transplantation can take place, the person receiving the transplant will need to have aggressive high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body.
This can put a big strain on the body so transplantations are usually only successful when they are carried out in children and young people, or older people who are in good health, and when there is a suitable donor, such as a brother or sister.
Read about bone marrow transplantation for more information