What types of treatment are used?

Types of treatment

Your doctor plans your treatment by taking into consideration a number of factors, including the type of leukaemia, any chromosomal abnormalities within the leukaemia cells, and your age and general health. In the UK, treatment for acute lymphoblastic leukaemia is usually given according to guidelines which have been agreed by specialists and are based on the results of trials and research. Trials are also co-ordinated 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.

The aim of treatment for acute lymphoblastic leukaemia (ALL) is to destroy the leukaemia cells and allow the bone marrow to work normally again. Chemotherapy is the first and main form 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. For this reason, 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 with ALL. This is known as remission. In some people the ALL will come back (relapse), usually 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. This treatment can give a further remission in about 1 in 3 people.

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 a bone marrow 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 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 and you will usually be asked 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 have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

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 and 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, and the staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, immediately so that he or she 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.

The benefits and disadvantages of treatment

Many people are frightened by the idea of cancer treatments, particularly because of the side effects that can occur. Some people ask what would happen if they had no treatment.

Although many of the treatments can cause side effects, knowledge about how these treatments affect people, and improved ways of reducing or avoiding many of these problems, have made most of the treatments much easier to cope with.

Treatment can be given for different reasons and the aims and possible benefits will vary depending upon the individual situation. For 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 chemotherapy, or a stem cell or bone marrow transplant.

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) or it 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.

If you have been offered treatment that aims to cure your leukaemia, deciding whether to accept 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 period of 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.