Chemotherapy for ALL
Chemotherapy uses drugs to kill leukaemia cells or slow their growth.
Treatment protocols set out which chemotherapy drugs to have, how much and how often. You can find information about protocols at eviq.org.au, although your haematologist may need to tailor the drugs to your individual situation.
For acute lymphoblastic leukaemia (ALL), chemotherapy is usually given in three main phases over 1–3 years. The first two phases (induction and consolidation) involve high-dose chemotherapy, so most people need to stay in hospital for several weeks. This process is described below.
You may have a bone marrow biopsy or lumbar puncture during chemotherapy to see how the treatment is working.
Learn more about:
- Side effects of chemotherapy treatment
- Intrathecal chemotherapy
- Phases of chemotherapy treatment for ALL
- Video: What is chemotherapy?
Chemotherapy drugs mainly kill fast-growing cells, such as leukaemia cells. However, other fast-growing cells, such as hair follicles, blood cells, and cells inside the mouth or bowel, can also be affected.
This can cause:
- hair loss
- high risk of infection
- mouth ulcers
- constipation or diarrhoea.
For more on this, see Managing side effects for ALL
Some people with ALL have leukaemia cells in the fluid around their brain and spinal cord (cerebrospinal fluid) at the time of diagnosis. In other people, the leukaemia cells spread to the cerebrospinal fluid after remission.
Chemotherapy drugs given intravenously or as tablets cannot get into the cerebrospinal fluid, so the drugs need to be injected directly into the spinal column using a lumbar puncture. This is called intrathecal chemotherapy.
After the procedure, you may have to lie on your back for a short time to help prevent a headache starting. Your doctor will discuss any other potential side effects with you before the procedure.
Chemotherapy for ALL is generally given in three phases:
Depending on the features of the leukaemia, you may have some or all of these phases of treatment.
You will have several drugs in different combinations in each phase of treatment. Some chemotherapy drugs are given into a vein (intravenously) and others are given as a tablet.
The entire process can take 1–3 years, with the maintenance chemotherapy phase taking up most of the treatment time.
- The aim of induction chemotherapy is to bring about (induce) remission. This means leukaemia cells are no longer found in bone marrow samples, the normal marrow cells return and blood counts become normal.
- You’ll have an intensive course of 3–4 drugs given at frequent intervals over 1–4 weeks. You’ll need to stay in hospital for 2–5 weeks.
- The drugs are often given through a central venous access device (CVAD) inserted into a vein in your upper arm or chest. The CVAD will be put in place under a general or local anaesthetic, and then left in throughout the induction phase. This makes regular injections more comfortable. The CVAD can also be used to take blood samples for testing.
- As the leukaemia cells die, they release a chemical called uric acid. This may build up and damage the kidneys, but can be controlled with medicine and intravenous fluids.
- You will have a bone marrow biopsy to check how well the treatment has worked. If no leukaemia cells are seen, this is called remission.
- If the biopsy shows leukaemia cells in the bone marrow, you may be given more chemotherapy, at similar or higher doses.
- Consolidation chemotherapy is also called post-remission therapy or intensification. It is given after remission is achieved.
- The aim is to kill any cells that may have survived the induction chemotherapy and to stop ALL coming back and/or spreading to the central nervous system.
- You will have several cycles of high-dose chemotherapy over 6–12 months.
- The type of chemotherapy drugs you are offered will depend on your risk of recurrence.
- Depending on the types of drugs used, you will either visit the hospital for treatment as an outpatient or stay in hospital for several nights.
- If your chance of recurrence is high, you may be offered further induction chemotherapy or a stem cell transplant
- Maintenance chemotherapy is commonly given after consolidation chemotherapy has finished. (It will not be needed if you have a stem cell transplant.)
- The aim is to increase how long you are in remission and prevent the leukaemia from coming back.
- You will take chemotherapy tablets either daily or weekly. You may also have intravenous chemotherapy and/or be offered steroids.
- This maintenance phase usually lasts between 18 months and 2 years.
- Maintenance chemotherapy is usually given as an outpatient. However, you may need to stay in hospital for some types of chemotherapy drugs.
Immunotherapy for ALL
Immunotherapy uses the body’s own immune system to fight cancer. CAR-T cells, a type of immunotherapy, has been shown to help some people with ALL that has come back or not responded to treatment. Ask your doctor about recent developments and whether you are a suitable candidate. You may also be able to access other new immunotherapy drugs to treat ALL through clinical trials.
Video: What is chemotherapy?
A/Prof John Moore (Conjoint UNSW), Senior Staff Specialist Haematology, Department of Haematology and Bone Marrow Transplant, Kinghorn Cancer Centre, St Vincent’s Hospital; Glynda Blomson, Consumer; Kevin Bloom, Senior Social Worker, Haematology and Bone Marrow Transplant, Royal North Shore Hospital; Sharon Frazer, Consumer; Prof Angela Hong, Radiation Oncologist, Chris O’Brien Lifehouse, and Clinical Professor, The University of Sydney; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Karen Maddock, Clinical Nurse Consultant – Haematology, Westmead Hospital.
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Learn more about how chemotherapy is the use of drugs to kill or slow the growth of cancer cells.
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