Maintenance treatments for acute lymphoblastic leukemia

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Maintenance treatment for acute lymphoblastic leukemia (ALL) is given to maintain remission. It is usually given over a long period of time and often lasts for 2 to 3 years. Maintenance treatments may be shorter if more intense treatments were given in the earlier treatment phases.

Some subtypes of ALL, such as T-cell ALL and Burkitt-type leukemia (mature B-cell ALL), may not need maintenance treatment.

You may be offered the following maintenance treatments for ALL. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.


Chemotherapy is the primary maintenance treatment for ALL. The drugs are usually given in lower doses and cause fewer side effects. The most common drugs used in maintenance treatment are:

  • methotrexate, often given weekly
  • mercaptopurine (Purinethol), often given daily

Other drugs that may be added to your treatment include monthly:

  • vincristine
  • prednisone or dexamethasone

Find out more about chemotherapy for ALL.

Targeted therapy

Targeted therapy is treatment that uses drugs or other substances to target specific molecules (usually proteins) involved in cancer cell growth while limiting harm to normal cells.

Targeted therapy is a standard treatment if the leukemia cells have the Philadelphia chromosome (called Ph-positive ALL or Ph+ ALL). This happens when genetic material swaps between chromosomes 9 and 22, resulting in an abnormal chromosome and creating a new gene. The new gene is called BCR-ABL.

During the maintenance phase of treatment, people with Ph+ ALL continue taking a targeted therapy drug called a tyrosine kinase inhibitor (TKI). The most common targeted therapy used to treat Ph+ ALL is imatinib (Gleevec). If this doesn't work, you may be offered the drug dasatinib (Sprycel) or another TKI.

Find out more about targeted therapy for ALL.

Central nervous system prophylaxis or treatment

With ALL, leukemia cells can spread to the brain and spinal cord (called the central nervous system, or CNS). Treatment given to prevent leukemia cells from spreading to the CNS is called CNS prophylaxis. CNS prophylaxis is started with induction treatment and may continue during consolidation and maintenance treatment with one or more of the following:

  • intrathecal chemotherapy with methotrexate, cytarabine or a steroid such as prednisone
  • high-dose methotrexate given intravenously (through an IV)
  • radiation therapy to the brain and spinal cord

Intrathecal chemotherapy gives chemotherapy drugs directly into the spaces containing cerebrospinal fluid (CSF), which is fluid around the brain and spinal cord. This type of chemotherapy is given through a lumbar puncture (also called a spinal tap) or an Ommaya reservoir.

Supportive therapy

Supportive therapy is important during every phase of treatment for ALL. It is used to treat the complications that usually happen with treatments for ALL and complications from the leukemia itself.

Supportive therapy during maintenance treatment may include:

  • antibiotics, antivirals or antifungals to prevent or fight infections
  • growth factors to help the bone marrow recover from chemotherapy and make more blood cells (chemotherapy can lower the white blood cell count, which increases your risk for infection)
  • transfusions of red blood cells, platelets, fresh frozen plasma and cryoprecipitate (a product that replaces clotting factors) as needed

Find out more about supportive therapy for ALL.

Clinical trials

Talk to your doctor about clinical trials open to people with ALL in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Expert review and references

  • Kareem Jamani, MD, LMCC, FRCPC
  • Goekbuget N, Hoelzer D . Diagnosis and Treatment of adult acute lymphoblastic leukemia. Wiernik PH, Goldman JM, Dutcher JP & Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 20: pp. 331-354.
  • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Acute Lymphoblastic Leukemia (Version 2.2021) . 2021:
  • PDQ® Adult Treatment Editorial Board. Adult Acute Lymphoblastic Leukemia Treatment (PDQ®) – Health Professional Version. Bethesda, MD: National Cancer Institute; 2021:
  • Kebriaei P, Ravandi F, de Lima M, Champlin R. Management of acute leukemias. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 102:1742–1763..
  • American Society of Clinical Oncology (ASCO) . Leukemia - Acute Lymphocytic - ALL. 2017 :
  • American Cancer Society . Treating Acute Lymphocytic Leukemia (ALL) . 2021 :
  • Seiter K. Medscape Reference: Acute Lymphoblastic Leukemia (ALL) Treatment & Management. New York, NY: WebMD LLC; 2021:
  • PDQ® Adult Treatment Editorial Board. Adult Acute Lymphoblastic Leukemia Treatment(PDQ®) – Patient Version. Bethesda, MD: National Cancer Institute; 2021:

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