Maintenance treatments for acute lymphocytic leukemia

Maintenance treatment for acute lymphocytic leukemia (ALL) is given to maintain remission. It is usually given over a long period of time and often lasts for 2–3 years. Maintenance treatments may be shorter if more intense regimens 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.


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

  • methotrexate
  • mercaptopurine (Purinethol, 6-MP)

Other drugs that may be added to the regimen include:

  • vincristine (Oncovin)
  • prednisone

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.

A targeted therapy drug called a tyrosine kinase inhibitor may be added to the chemotherapy regimen for people with leukemia cells that have the Philadelphia chromosome (called Ph+ ALL). The most common targeted therapy used to treat Ph+ ALL is imatinib (Gleevec).

Central nervous system prophylaxis

The central nervous system (CNS) is the brain and spinal cord. 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:

  • chemotherapy given directly into the spinal fluid (called intrathecal chemotherapy) with methotrexate, cytarabine or a steroid such as prednisone
  • high-dose methotrexate given intravenously
  • radiation therapy to the brain

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 the disease 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 (chemotherapy can affect the bone marrow so it doesn’t make enough healthy blood cells, which can increase the risk for infection)
  • transfusions of red blood cells, platelets, fresh frozen plasma and cryoprecipitate (a product that replaces clotting factors) as needed

Clinical trials

You may be asked if you want to join a clinical trial for ALL. Find out more about clinical trials.

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.