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Guidelines & Advice

Acute Lymphoblastic Leukemia: What to Expect During Intensive Chemotherapy Treatment

This page is for people newly diagnosed with ALL.

Being diagnosed with acute lymphoblastic leukemia (ALL) can be overwhelming. ALL is life-threatening but most patients will be treated to try to cure the cancer. Your treatment will start very soon after your diagnosis.

During your treatment, be open with your healthcare team about your questions and concerns. Keep track of your questions between your appointments so that you can get all of the information you need. Your healthcare team is there to help you.

The links below will offer you some information about what to expect. Talk to your healthcare team about your treatment details.

How ALL is treated

Your ALL may be treated with chemotherapy, targeted therapy or a combination of these 2 types of treatments. Depending on your leukemia you may also get other kinds of treatments.

Chemotherapy is medication used to kill leukemia cells. You will get chemotherapy in most phases of your treatment.

Chemotherapy for acute lymphocytic leukemia (Canadian Cancer Society).

Targeted therapy is a type of drug that targets certain parts of the cancer such as genes or protein. If you have Philadelphia chromosome positive ALL you will get targeted therapy called a tyrosine kinase inhibitor (TKI) as well as chemotherapy during most of the phases of your treatment. TKI is usually a pill that you swallow. The TKI medication kills leukemia cells that have the Philadelphia chromosome. There are other targeted therapies used as well.

Targeted therapy for acute lymphocytic leukemia (Canadian Cancer Society)

Length of Treatment

Your ALL treatment happens in phases, which are described in more detail in the next section, Phases of Treatment: What to Expect. Your overall treatment will take between 2 and 3 years.

For an overview of what your treatment may look like, please visit Treatments for acute lymphocytic leukemia (Canadian Cancer Society)

Phases of Treatment: What to Expect

Your treatment plan will be designed just for you. Your personal plan will depend on many different things such as your age, your overall health and some details about your leukemia.

For more information about the different phases that you may have in your ALL treatment, please visit the following links.

Induction chemotherapy is designed to quickly kill leukemia cells. The goal of this phase of treatment is to get your bone marrow and your blood counts back to normal.

Induction treatments for acute lymphocytic leukemia (Canadian Cancer Society)

Post induction treatment comes after induction chemotherapy and it includes:

Consolidation
Intensification
CNS (central nervous system) prophylaxis/treatment

Your central nervous system is made up of your brain and your spinal cord. This phase of treatment may be given into your vein and/or directly into your spinal column. Radiation treatment may also be needed. The goal is to kill even more leukemia cells, and to treat and/or stop them from getting into your central nervous system

Consolidation treatments for acute lymphocytic leukemia (Canadian Cancer Society)

Maintenance or continuation chemotherapy is usually a lower dose of chemotherapy that kills more cancer cells and can stop any more leukemia cells from growing over a longer period of time.

Maintenance treatments for acute lymphocytic leukemia (Canadian Cancer Society)

In some cases ALL may be treated with stem cell transplant. For ALL the stem cell transplant is almost always allogeneic, which means that the cells for transplant come from a donor. For the stem cell transplant, you will be given high doses of chemotherapy to kill leukemia cells. After the chemotherapy the donor cells are put into your bone marrow so that it can recover.

Stem cell transplant (Canadian Cancer Society)

Side Effects of Treatment: How to Manage Them

Your ALL treatment includes strong doses of chemotherapy that will cause side effects. At times your side-effects may be very bothersome and cause you to feel unwell.

Your healthcare team will work with you to make a plan to manage side-effects as much as possible. There are also some things you can do at home to help manage side-effects.

For an overview of side-effects and tips for things you can do at home to feel better, please visit the links below:

Ask your healthcare team about other side-effects you may have such as:

Steroid induced diabetes
Steroid related muscle weakness or pain
Blood clots

Effects of ALL Treatment: How it Will Impact Your Life

Your ALL treatment is a long process that will impact many different areas of your life.

Fertility

ALL treatment will likely make it hard or impossible for both men and women to have a baby. If fertility is a concern for you or your partner, there may be things you can do so that you can have a baby in the future.

Fertility problems (Canadian Cancer Society)

Sex and intimacy

When having treatment for ALL, you may notice many changes in your sexual life. These changes may be from physical or emotional side-effects of your treatment.

Sexual health (Ontario Health [Cancer Care Ontario])

Coping with emotions

Going through treatment for ALL is draining and may cause you to have feelings of depression and anxiety, as well as other emotions. It is normal to need a lot of support and therapy during your treatments and after they are over.

Anxiety (Ontario Health [Cancer Care Ontario])

Depression (Ontario Health [Cancer Care Ontario])

Your emotions and cancer (Canadian Cancer Society)

Work

At some point during or after your ALL treatment you may feel ready to go back to work. When you do there are many things to consider in order to make your return safe and positive.

Cancer and Work (McGill University and BC Cancer)

Prepare to return to work after cancer treatment (University Health Network)

Travel

Ask your health team if it is safe for you to travel. It will depend on your health, side effects and which treatment phase you are in. If you are able to travel, it is important to look into getting health insurance coverage before you leave on your trip.

Acute Lymphoblastic Leukemia: What to Expect During Intensive Chemotherapy Treatment

How ALL is treated

Length of Treatment

Phases of Treatment: What to Expect

Side Effects of Treatment: How to Manage Them

Fatigue:

Low blood cell counts:

Constipation:

Peripheral neuropathy:

Nausea and vomiting:

Loss of appetite:

Sore mouth and throat:

Hair loss:

Diarrhea:

Skin problems: