Chemotherapy for acute lymphocytic leukemia

Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. Long-term chemotherapy is the main treatment for acute lymphocytic leukemia (ALL). It is given in 3 phases, usually for 2–3 years. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is given for different reasons. You may have chemotherapy to:

  • destroy leukemia cells, bring about a remission and return blood cell production to normal
  • prevent leukemia cells from spreading to or treat leukemia cells in the brain and spinal cord (called the central nervous system, or CNS)
  • prepare for a stem cell transplant

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body. Chemotherapy may also be a regional therapy, which means that it is given to a specific area of the body. Intrathecal chemotherapy is given into the spaces containing cerebrospinal fluid (CSF) through a lumbar puncture (also called a spinal tap) or an Ommaya reservoir.

Preparing for chemotherapy

Some people may need to have the following surgical procedures before chemotherapy.

The surgeon may place a central venous catheter in a vein in the upper chest. The healthcare team can use this catheter to draw blood and give drugs so you won’t need as many injections. Find out more about a central venous catheter.

If you are receiving intrathecal chemotherapy, the surgeon may place an Ommaya reservoir beneath the scalp. An Ommaya reservoir is a small, dome-shaped device with a short tube, or catheter, attached to it. The healthcare team gives the chemotherapy drug by inserting a small needle through the scalp into the Ommaya reservoir. The drug goes directly into the spaces containing cerebrospinal fluid.

Chemotherapy drugs used for ALL

Chemotherapy for ALL usually involves a combination of drugs. Drugs used to treat ALL are:

  • vincristine (Oncovin)
  • daunorubicin (Cerubidine, daunomycin)
  • doxorubicin (Adriamycin)
  • cytarabine (Cytosar, Ara-C)
  • asparaginase (Kidrolase)
  • etoposide (Vepesid, VP-16)
  • teniposide (Vumon, VM-26)
  • mercaptopurine (Purinethol, 6-MP)
  • methotrexate
  • cyclophosphamide (Cytoxan, Procytox)

Steroids, such as prednisone or dexamethasone (Decadron, Dexasone), may be used in combination with chemotherapy.

The most common chemotherapy combination used for induction therapy to treat ALL is vincristine, daunorubicin or doxorubicin, and prednisone. Different versions of this regimen may also include:

  • cyclophosphamide
  • asparaginase
  • etoposide
  • high-dose methotrexate
  • high-dose cytarabine
  • pegaspargase (Oncaspar)

A common chemotherapy combination used for consolidation treatment for ALL is hyper-CVAD, which is cyclophosphamide, vincristine, doxorubicin and dexamethasone. Hyper-CVAD is alternated with high-dose cytarabine and high-dose methotrexate.

The most common chemotherapy combination used for maintenance treatment for ALL is methotrexate and mercaptopurine. Other drugs that may be added to the regimen include vincristine and prednisone.

If ALL does not respond to drugs used in earlier treatments or if it recurs, the following drugs may be used:

  • etoposide and cytarabine
  • high-dose methotrexate
  • high-dose cytarabine

Central nervous system prophylaxis or treatment

The central nervous system (CNS) is the brain and spinal cord. Treatment given to prevent the leukemia cells from spreading to the CNS is called CNS prophylaxis. Treatments are also given if ALL has spread to the CNS.

To prevent ALL from spreading to the CNS or treating ALL in the CNS, drugs are given directly into the spaces containing cerebrospinal fluid through a lumbar puncture or an Ommaya reservoir.

The most common chemotherapy drugs used for CNS prophylaxis or treatment for ALL in the CNS are:

  • methotrexate
  • cytarabine
  • a steroid such as prednisone

Side effects

Side effects can happen with any type of treatment for ALL but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug or drug combination, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for ALL are:

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Information about specific cancer drugs

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.

Questions to ask about chemotherapy

Find out more about chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.

Expert review and references

  • American Cancer Society. Leukemia - Acute Lymphocytic (Adults). Atlanta, GA: American Cancer Society; 2013.
  • American Society of Clinical Oncology (ASCO). Leukemia - Acute Lymphocytic - ALL: Treatment Options. Alexandria, VA.: American Society of Clinical Oncology (ASCO); 2013:
  • 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.
  • Kebriaei P, Champlin R, de Lima M, et al . Management of acute leukemias. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014: 131: pp. 1928-1954.
  • Kurtin SE . Leukemia and myelodysplastic syndromes. Yarbro, CH, Wujcki D, & Holmes Gobel B. (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 57: pp. 1369-1398.
  • National Cancer Institute. Adult Acute Lymphoblastic Leukemia Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.