You may be offered:

Chemotherapy
Chemotherapy uses special drugs to kill cancer cells. It is the main type of treatment for ALL.

Your doctor will take several factors into account when planning your chemotherapy, including the exact type of leukaemia you have, and your age.

Most patients need to stay in hospital for some time during their initial phase of chemotherapy, which is given over a period of 12-20 weeks.

Usually, the drugs are given as a series of injections. To make this easier and more comfortable for you, your nurse or doctor may put a thin plastic tube (a Hickman line) into a vein in your chest. Another method is to use a PICC line, which is fed through a vein in the arm and into a large vein in the chest. You have a local anaesthetic before the doctor or nurse puts in the line. Once it is in place, it stays there throughout your treatment. Each time you have chemotherapy your nurse injects the drugs painlessly through the line. S/he can also use the line to take samples of blood.

For another part of the chemotherapy treatment you will have an injection of drugs into the fluid around the brain and spinal cord, to kill any cancer cells that have got into the fluid. This is done through a procedure called a lumbar puncture, and you have a local anaesthetic first.

The aim of chemotherapy is to kill all the leukaemia cells, so that your normal bone marrow can start to grow again. If this happens, the doctor will say that you are in remission. If there are no signs of active disease, this is called complete remission. If there is an improvement but the leukaemia is still there, this is a partial remission.

Most patients who go into complete remission then have maintenance therapy for two years afterwards. They take chemotherapy drugs (mostly by mouth), and attend check-up appointments at the haematology outpatients clinic. The aim is to improve the chances of moving from remission to cure.

Radiotherapy
Some patients need to have radiotherapy to the head and spine, to try to destroy any cancer cells that have got into the spinal fluid.

Radiotherapy uses radiation to kill cancer cells. For leukaemia, it is given from outside the body – this is called external beam radiotherapy.

Some ALL patients are treated with chemotherapy and radiotherapy alone, but in some cases the doctor may think there is a better chance of cure if the chemotherapy is followed by stem cell rescue or a donor bone marrow transplant.

High dose chemotherapy with stem cell rescue
Some chemotherapy patients will be offered high dose chemotherapy with stem cell rescue.

Chemotherapy can damage bone marrow and lead to problems such as anaemia, infections and bleeding.

After standard chemotherapy, bone marrow recovers on its own, but high dose chemotherapy does more damage, and bone marrow needs help to recover.

Before you have high dose chemotherapy your doctors will take some stem cells from you. These are stored, ready to give back to you afterwards. When they are put back into your body the cells start to grow and multiply again.

There are two ways of getting the stem cells. The most usual way is to get them from the blood. A special machine collects bone marrow cells that are circulating in the blood. This is called peripheral blood stem cell harvesting. Less usually, some bone marrow is removed. This is called bone marrow harvesting.

After harvesting, you have your high dose of chemotherapy. Later your undamaged blood stem cells (or bone marrow) are given back to you through a drip.

The chemotherapy and stem cell rescue will involve a stay in hospital of two or three weeks.

Allogenic (donor) bone marrow transplant
In some cases the doctor may recommend a donor bone marrow transplant, usually after chemotherapy. This means taking healthy bone marrow cells from another person (a donor) and giving them to the patient.

The cells are normally taken from a close relative such as a brother or sister whose bone marrow is very like the patient's. If there is no close relative, doctors may be able to find another donor from a bone marrow register. The transplant can go ahead only if the donor is a close match.

Most younger patients with ALL are offered a transplant, if there is a donor available.

If your ALL doesn't respond to treatment, or if it comes back later, your doctor will need to talk with you about other options. For example s/he may suggest trying different chemotherapy drugs.

Giving your consent
Your doctors will tell you about the risks, benefits and side-effects of your treatment options. You will need to agree to the treatment before it can start. This is called giving your consent. Don't be afraid to ask questions if there is anything you don't understand.