The aim of treatment for acute lymphoblastic leukaemia (ALL) is to destroy the leukaemia cells and allow the bone marrow to work normally again.
The multidisciplinary team of doctors and other staff at your hospital will plan your treatment, taking into account a number of factors, including:
the type of ALL you haveany chromosomalabnormalities within the leukaemia cellsyour age and general health.In the UK, treatment for acute lymphoblastic leukaemia is given according to guidelines which have been agreed by specialists and are based on the results of trials and research. Trials are also coordinated in the same way and you may be asked if you are willing to take part in a trial of a new and possibly better treatment.
Chemotherapy is the first and main type of treatment given. The chemotherapy is carried in the bloodstream to nearly all parts of the body, but does not reach the brain and spinal cord, and in men it does not reach the testes. So, additional treatment may be needed, where chemotherapy is given into the fluid around the brain and spinal cord. This is sometimes combined with radiotherapy to the brain. Men may be given radiotherapy to the testes. Radiotherapy given in this way to the brain and spinal cord or the testes is known as prophylactic radiotherapy.
Chemotherapy can get rid of the leukaemia cells in up to 8 out of 10 people (80%) with ALL. This is known as remission. In some people the ALL will come back (relapse). If this happens it will usually be within a few years of the treatment. If ALL does come back, further treatment can be given either with standard-dose chemotherapy or high-dose chemotherapy with stem cell support. This treatment can give a further remission in about 1 in 3 people (33%).
In some people with ALL, certain factors make it more likely to come back after treatment. This is known as being at high risk of relapse. In this situation, high-dose chemotherapy and a stem cell transplant from a donor may give a better chance of curing the leukaemia than standard-dose chemotherapy and may be recommended as a treatment option.
If you have any questions about your treatment, don’t be afraid to ask your doctor or specialist nurse. It often helps to make a list of questions for your doctor and to take a close friend or relative with you.
Giving your consent
Before you have any treatment, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:
the type and extent of the treatment you are advised to havethe advantages and disadvantages of the treatment any other possible treatments that may be availableany significant risks or side effects of the treatment.If you don't understand what you have been told, let the staff know straight away so that they can explain again. Treatments for leukaemia can be very complex, so it is not unusual for people to need further explanations.
It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.
Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.
You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is important to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.
Benefits and disadvantages of treatment
Many people are frightened by the idea of cancer treatments, because of the side effects that can occur. Some people ask what will happen if they do not have treatment. Although many of the treatments can cause side effects, these can often be controlled or reduced with medicines. Treatment can be given for different reasons and the aims and possible benefits will vary depending upon the individual situation.
Newly diagnosed ALL
In people who have just been diagnosed with ALL it is important to start treatment very quickly as this gives a good chance of curing it. Without treatment people may die of the leukaemia within a few weeks. The treatment may be standard-dose chemotherapy, or high-dose chemotherapy followed by a stem cell transplant.
Relapsed or recurrent ALL
If the leukaemia has come back after initial treatment, further treatment may be able to get rid of the leukaemia again for a time (known as a remission). Sometimes the treatment may only be able to control the leukaemia, leading to an improvement in symptoms and a better quality of life. However, for some people in this situation the treatment will have no effect upon the leukaemia and they will get the side effects without any of the benefit.
Treatment decisions
If you have been offered treatment that aims to cure your leukaemia, deciding whether to have the treatment may not be difficult. However, if a cure is not possible and the treatment is being given to control the leukaemia for a time, it may be more difficult to decide whether to go ahead. Making decisions about treatment in these circumstances is always difficult, and you may need to discuss this issue in detail with your doctor. If you choose not to have treatment, you can still be given supportive (palliative) care, with medicines to control any symptoms. If you want to stop your treatment, it is important to tell a doctor, or the nurse in charge. They can discuss your decision with you and offer you the best advice. They will also make a record of your decision in your medical notes.
Second opinion
Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors would normally be pleased to refer you to another specialist. However, a second opinion can sometimes take time to arrange. As treatment for ALL should be started as soon as possible there may not be time to arrange this for you. If you would like to get a second opinion it is a good idea to discuss this with your specialist when you first see them.
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