ALL treatment im Depth

Question 1

What are the phases of treatment for ALL?

Answer 1

• Steroid pre phase
• Induction
• Consolidation
• Intensification
• Maintenance

Question 2

What is the steroid pre phase?

Answer 2

• The aim is to destroy as many leukaemia cells as possible
• You take steroids up to a week before you start chemotherapy

Question 3

What is complete remission in the steroid pre phase?

Answer 3

• there is no sign of leukaemia in your bone marrow
• your blood cell count is back to normal

Question 4

What are the examples of steroids used in cancer treatments?

Answer 4

• Prednisolone
• Methylprednisolone
• Dexamethasone
• Hydrocortisone

Question 5

What do steroids do ?

Answer 5

• regulate BP
• balance salt and water in your body
• reduce allergies and inflammation
• helps your metabolism
• controls your mood and behaviour

Question 6

How do steroids work in cancer treatment?

Answer 6

• treat the cancer itself
• reduce inflammation
• reduce the body’s immune response
• reduces sickness when having chemotherapy
• improves your appetite

Question 7

How do you take the steroids?

Answer 7

• tablets or liquid
• infection into the vein

Question 8

When do you have steroids?

Answer 8

• every other day
• once a day
• several times a day

Question 9

How many weeks do you take steroids before until you need a steroid card?

Answer 9

• 3 weeks

Question 10

What side effects might you have if you stop steroids suddenly?

Answer 10

• pale, cold, clammy skin
• sweating
• fast, shallow breathing
• dizziness
• feeling sick
• diarrhoea

Question 11

What are the side effects of steroids?

Answer 11

• increased risk of infection
• mood changes
• induced diabetes ( changes to blood sugar levels)
• increased appetite and weight gain
• fluid build up
• ingestion and heart-burn
• changes to face and appearance
• high BP
• eye problems ( cataracts, glaucoma, eye infections, changes to vision)
• skin changes ( rashes, bruising and thinning)
• osteoporosis
• vertigo
• thinning of hair
• more hair
• muscle wasting
• growth problems

Question 12

What is involved in the Induction Phase of ALL?

Answer 12

• Induction involves many chemotherapy drugs over a few days
• You will typically need to stay in hospital for the duration of recovery this is typically 4-6 weeks
• You have IV fluids and preventative Abx
• You may also receive chemotherapy into the fluid surrounding the spinal cord and the brain ( known as intrathecal chemotherapy)
• Once you have finished the induction phase and the blood count is recovered you can have another bone marrow test - this is a sensitive test which is used to check if there is any remaining leukaemia cells in your body

Question 13

What is involved in consolidation and intensification?

Answer 13

• Even if your leukaemia is in remission with the first cycle of treatment in induction/ pre phase steroids
• The leukaemia needs to continued to be treated to ensure it doesn’t come back
• treatment options are more chemotherapy, this tends to be at higher doses and the treatment is stronger, treatment tends to be in cycles such as blocks
• targeted cancer treatment (Philadelphia positive leukaemia = tyrosine kinase inhibitors)
• blinatumomab - monoclonal antibody cancer drug (used for people with high levels of MRD after induction)
• Bone marrow/ stem cell transplant

Question 14

What is Maintenance Therapy?

Answer 14

• You typically have low doses of chemotherapy everyday as a tablet
• You have short courses of steroids known as pulses
• You have injections of chemotherapy every 3 months, this lasts around 2 years.
• You make have intrathecal chemotherapy ( via the spine to clear the CSF and the brain)
• You have regular blood tests and meet with your doctor to track your progress