At UCLH you will have access to the latest treatments and technology and have a personal, individual care plan based around your needs. ALL patients at UCLH are offered the standard treatments and also in most cases are offered the chance to enter a clinical trial. You will receive expert care from an experienced team in a safe and award winning environment.

Your treatment will be delivered within a number of comprehensive specialised services led by medical and nursing cancer care experts. This is enhanced further by support from a dedicated team of Clinical Nurse Specialists (CNS) and Clinical Trials Nurses and Practitioners who complement the medical team and will oversee your treatment journey. They offer on-going support from diagnosis and treatment to investigations and outcomes. This includes telephone advice and support when you are at home.

Our adult inpatient facility is housed over three floors of University College Hospital, wards T13 North, T14 North and T16. Nearly all of our beds are in single rooms with en suite facilities which have the provision for a family member to stay overnight. On both wards, the average nurse to patient ratio is one nurse for every three or four patients. Day case, ambulatory care and outpatient care is provided from the state-of-the-art University College Hospital Macmillan Cancer Centre.

Your treatment plan

The medical team will recommend a treatment plan and discuss this with you as soon as the diagnosis has been made, as it is extremely important to start treatment as soon as possible. Treatment plans are tailored to each individual and their type of ALL. The main factors to consider are:

  • The patient’s opinion on which treatment(s) they want to receive
  • Patient fitness to receive intensive chemotherapy treatment
  • Medical opinion on which treatment is most effective to control the disease

Most people will commence steroid treatment whilst their treatment plan is being confirmed. The steroids will immediately start treating the leukaemia whilst the patient is being prepared for chemotherapy.

Intensive treatment

You will be given various types of chemotherapy to kill the leukaemia cells in your bone marrow. Although some medications may be given as pills, you will need more than one medication given as an infusion. To make things easier and avoid repeated injections, they can all be given via one flexible tube into a vein in your chest called a PICC (Peripherally Inserted Central Catheter) line.

Some chemotherapy medication will also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may be present. This is given using a needle that is placed into your spine, in a similar way to a lumbar puncture.

Side effects that occur following chemotherapy are common:

  • Infection – minor and major
  • Bleeding and bruising
  • Nausea and Vomiting
  • Diarrhoea
  • Loss of appetite
  • Painful mouth and throat
  • Fatigue
  • Skin rashes
  • Hair loss
  • Fertility issues – not always permanent and where possible fertility preservation is offered

The side effects should resolve once treatment has finished. Your hair will usually take between three to six months to grow back.

The induction stage of treatment is carried out as an inpatient in UCLH and will last about 4 weeks. At this stage you may be vulnerable to infection, so it is important that you are in an environment where you can be carefully monitored and any infection that you have promptly treated. As chemotherapy temporarily affects the production of normal blood cells you are likely to need regular blood and platelet transfusions.

If you have a type of leukaemia known as Philadelphia chromosome-positive ALL, you will also be given a medicine called imatinib. Imatinib works by blocking the signals in the cancerous cells that cause them to grow and reproduce.

Imatinib is taken orally (as a tablet). The side effects of imatinib are usually mild and should improve over time. They include:

  • Nausea and vomiting
  • Swelling in the face and lower legs
  • Muscle cramps
  • Skin rash
  • Diarrhoea

Following induction chemotherapy, the medical team will assess the response of your disease by undertaking a bone marrow test and any appropriate scans. This will enable the team to compare the results with the diagnostic tests and decide on the best next course of treatment.

The maintenance phase, which can last for up to two years, is designed to act as further insurance against the possibility of the leukaemia returning. It involves taking regular doses of chemotherapy tablets, and less frequent intravenous and lumbar puncture chemotherapy. The treatment is given as an outpatient and most people can return to work or education during this phase.

Leukaemia can return if residual cancerous cells remain in your body. Therefore the aim of consolidation treatment is to ensure that any remaining leukaemia cells are killed.

Treatment involves receiving regular injections of chemotherapy medication. This is usually done on an outpatient basis, which means you will not have to stay in hospital overnight. However, you may require some short stays in hospital if your symptoms suddenly get worse or if you develop an infection.

The consolidation phase of treatment lasts several months.

Non-intensive treatment

If you are thought to have a high risk of experiencing complications of ALL treatment or have a serious underlying health condition a less intensive chemotherapy treatment may be an option. This is less likely to successfully kill all of the leukaemia cells in your body, but it can help control your condition and the associated symptoms. Usually, non-intensive chemotherapy has fewer and less severe side-effects and can be taken at home with outpatient support. In ALL this can include steroids and oral chemotherapy.

Side effects of non-intensive chemotherapy (less likely than intensive):

  • Infection – minor
  • Bleeding and bruising
  • Nausea and Vomiting
  • Diarrhoea
  • Loss of appetite
  • Painful mouth and throat
  • Fatigue
  • Skin rashes

Clinical Trials

In the UK, a number of clinical trials are currently underway that aim to find the best way to treat ALL. Clinical trials are studies that use new and experimental techniques to see how well they work in treating, and ultimately curing acute leukaemia. Patients may occasionally receive more experimental treatment and trials if their disease is not responding to conventional methods.

Stem Cell / Bone Marrow Transplants

Some patients with ALL will require a bone marrow transplant to give the best chance of obtaining a long-term cure. We ask newly diagnosed patients under the age of 70 to provide us with their sibling details and a sample of their own blood to assess if there is potential match for a bone marrow transplant within the family. If you do not have a sibling, or they do not match your tissue type, and need a transplant then we can search on the National (and International if needed) Database for Bone Marrow Donors.

At UCLH we recommend the following websites for patients and their relatives when diagnosed with ALL: