Treatment of Acute Lymphoblastic Leukaemia (ALL)

Symptoms of ALL develop quickly; a person is likely to become very ill with symptoms of their leukaemia over a few days or weeks. Symptoms of acute leukaemia are listed under symptoms. The initial diagnosis and treatment, including chemotherapy treatment is likely to be given as an in-patient in hospital, along with supportive care. After one cycle of chemotherapy in hospital the leukaemia will often be in remission. This cycle takes 4 weeks to administer. This first cycle of chemotherapy to induce remission is often called induction chemotherapy. In the UK a second cycle of inpatient chemotherapy is usually given which requires a further inpatient stay of 4-6 weeks. Further treatment involves treatment directed at the brain and requires several shorter admissions to hospital. Subsequent treatment can then usually be given as an out-patient. This will usually be in two phases

‘Consolidation’ – a high dose treatment to stop the leukaemia coming straight back

‘Maintenance’ a long course of lower dose drugs to keep the leukaemia at bay after consolidation treatment.

These two phases of treatment are likely to take two years. Treatment is likely to include at least two of the following drugs:

• Cytarabine
• Daunorubicin
• Thioguanine
• Etoposide
• Methotrexate
• Cyclophosphamide
• Doxorubicin
• Vincristine

Side effects associated with this treatment include:

• Myelopathy – damage to the spinal cord by drugs – numbness, tingling or difficulty moving are likely symptoms
• Peripheral neuropathy – numbness or tingling are common symptoms
• Fits
• Very severe tiredness
• Acute cerebellar syndrome – difficulty balancing when walking or difficulty walking at all are likely symptoms
• Pulmonary oedema – may cause shortness of breath
• Vincristine causes very severe constipation as part of peripheral nerve damage

A common alternative treatment to consolidation and maintenance is bone marrow or stem cell transplant

Click on the link for details of:

• Bone marrow transplant

ALL often affects the brain so it is common to have treatment to treat or prevent this including:

• Intrathecal chemotherapy
• Prophylactic cranial irradiation – this is a course of radiotherapy to the head

These treatments are responsible for some of the severe side effects above particularly myelopathy and very severe fatigue; this is because of the direct damage to the brain and spinal cord caused by the treatment.

Other treatments that may be used in addition to chemotherapy or bone marrow transplant include:

• G-CSF e.g. Neupogen or Granocyte (Granulocyte Colony Stimulating Factor these are growth factors to stimulate the production of normal blood cells by the bone marrow.
• Steroid drugs including prednisolone, methylprednisolone and dexamethasone. These drugs are used in short bursts during chemotherapy treatment. In general side effects are minimal. However if used for prolonged periods the following side effects are very common – significant weight gain, osteoporosis and diabetes mellitus. Rarer side effects include psychiatric problems ranging from depression and anxiety to full blown psychotic episodes.
• Biological therapy with Imatinib or Dasatinib.

Long term side effects of chemotherapy treatment

In the long term young people who have had intensive chemotherapy are at high risk of long term side effects of treatment – these are summarised here:

• Infertility
• Second cancers – this is 1 in 3 over the 10 years after treatment for ALL.
• Lung damage
• Psychological effects
• Late learning and memory difficulties
• Heart disease
• Endocrine dysfunction
• Sexual dysfunction
• Impaired immunity
• Chronic fatigue
• Anxiety and depression

Click on the links for details of:

• Side effects of Chemotherapy
• Biological Therapy
• Problems in adults who had cancer treatment as children

Amended February 2009