Acute lymphoblastic leukaemia is an aggressive condition that develops quickly, so treatment usually begins a few days after diagnosis.
Stages of treatment
Treatment for acute lymphoblastic leukaemia is usually carried out in three stages. They are:
- 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
The induction stage of treatment is carried out in hospital or a specialist centre. This is because you'll probably need regular blood transfusions as your blood won't contain enough healthy blood cells.
You'll also be vulnerable to infection, so it's important you're in a sterile environment where your health can be carefully monitored and any infection that develops can be treated quickly. Antibiotics may also be prescribed to help prevent further infection.
You'll have chemotherapy to kill the leukaemia cells in your bone marrow. Although some medications may be given as pills, you'll need more than one medication given as an injection. To make things easier and avoid repeated injections, they can all be given through a flexible tube (a 'central line') that goes into a vein in your chest.
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 and brain. The type of chemotherapy medication used is called methotrexate and it's given as an injection into your spine, in a similar way to a lumbar puncture.
After you've had the injection, you'll have to lie flat for a few hours with your head positioned slightly lower than your feet. You may have a headache or feel sick afterwards.
Methotrexate is also given intravenously (directly into a vein) in adults with acute lymphoblastic leukaemia after induction therapy and before consolidation.
Other common side effects following chemotherapy include:
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'll 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 won't have to stay in hospital overnight. However, you may need some short stays in hospital if your symptoms suddenly get worse or 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 having regular check-ups to monitor the effectiveness of your treatment.
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 can't 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) hasn't decided 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 (CCG) as to whether you'll be offered dasatinib.
Radiotherapy is where high doses of controlled radiation are used to kill cancerous cells. It's usually used to treat acute leukaemia in the following two situations:
- to 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 include:
These side effects should pass after your course of radiotherapy has been completed. However, your skin may be very sensitive to the effects of light for several months after 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 having 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 cataract surgery.
Stem cell and bone marrow transplants
A stem cell and bone marrow transplant is a possible alternative treatment option if you or your child don't respond to chemotherapy.
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're carried out in children and young people, or older people in good health, and when there's a suitable donor, such as a brother or sister.
Recent research has shown that it's possible for people over the age of 40 to have a reduced intensity stem cell transplant. This is where lower than normal doses of chemotherapy and radiotherapy are used before the transplant, which places less strain on the body.