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What Happens During Chemotherapy for Acute Lymphocytic Leukemia

You may receive chemotherapy during different phases of your treatment. The process may be relatively the same, but the types of drugs you get may change.

Chemotherapy for remission induction

The goal of remission induction is to kill leukemia cells so you no longer have symptoms. During this phase of treatment, you will most likely need to stay in the hospital. You may receive these drugs in pill form, by injection or IV (intravenous), or in more than one way.

You receive chemotherapy in cycles over a period of time. This means you may alternate taking the drugs with periods of not taking them. Having chemotherapy in cycles helps in many ways. It allows the drugs to kill more cancer cells because cells aren't all dividing at the same time. It allows your body to rest from the treatment, since chemotherapy also damages normal cells. It also gives you an emotional break between treatments.

In all treatment phases of ALL, it is standard to receive more than one chemotherapy drug at a time. This is called combination chemotherapy. This treatment reduces the chance that your cancer will develop a resistance to one drug, and improves the chance of successful treatment. Which drugs you get, as well as how often you receive them, depends on many factors. These factors include your general health, the subtype of ALL, and your doctor's experience.

During the remission induction phase, you usually receive chemotherapy drugs for ALL in a hospital. These are examples of drugs used during this phase.

  • Cytoxan or Neosar (cyclophosphamide)

  • Oncovin or Vincasar (vincristine)

  • Decadron or Dexameth (dexamethasone) or prednisone

  • Elspar (L-asparaginase)

  • Adriamycin (doxorubicin) or Cerubidine (daunorubicin)

  • Cytosar (cytarabine)

  • Folex (methotrexate)

  • VePesid (etoposide) 

Intrathecal chemotherapy

For ALL, it is common to receive intrathecal chemotherapy to try to kill or prevent the spread of cancer in your spine or brain. This is often started during the induction phase of chemotherapy. You receive this form of chemotherapy through a lumbar puncture or spinal tap, which is a shot in the lower part of your spine. You will likely receive a combination of methotrexate and cytarabine. A lumbar puncture can cause discomfort. Your doctor will tell you how many treatments you will receive. Your doctor may decide to give chemotherapy this way only during the remission induction phase, or he or she may decide to give it during later phases of treatment.

If your doctor plans long-term treatment for your brain, a surgeon can insert an Ommaya reservoir under your scalp with a minor operation that can take 15 to 20 minutes. After the procedure, your doctor or nurse can access the small, drum-like device under your scalp to deliver chemotherapy quickly and painlessly to the fluid around your brain. The Ommaya reservoir can also be used to take a sample of brain fluid which may allow the doctor to see if the treatment has been effective and to detect any sign of infection. When you no longer need the reservoir, the surgeon will remove it.

Chemotherapy for consolidation (intensification)

If the induction phase brings your leukemia into remission, the next phase of treatment is an intense, fairly short course of chemotherapy to try to kill any remaining cancer cells. This phase is known as consolidation or intensification. This phase includes many of the same drugs used in the induction phase, but usually at higher doses. Consolidation usually lasts for a few months. Intrathecal chemotherapy may be continued during this phase. 

Chemotherapy for maintenance treatment

The maintenance phase of chemotherapy may last two to three years. You need this phase of treatment because there still may be traces of leukemia cells in your body. The most common regimen for maintenance treatment includes methotrexate and Purinethol (6-mercaptopurine). 

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