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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Cancer treatments


With a central line, doctors can give IV chemo

treatments without “sticking” your vein with a needle

every time. Doctors can also use the central line

to give other medicines and take blood samples. A

central line can be left in place for weeks or months.

Leukemia cells can also spread to the brain

and spinal cord. This is called CNS disease.

Chemotherapy that is injected into a vein

cannot always reach this area. Instead, drugs

must be injected directly into the spinal fluid.

When drugs are given this way, it is called IT





hecal) therapy or IT chemotherapy. IT

chemotherapy is often given during a lumbar

puncture. (

See Figure 7

on page 22.) IT

chemotherapy is used to prevent and treat CNS


Chemotherapy treatment phases

The treatment of ALL is a long-term process that

lasts two to three years. ALL treatment is given

in three main steps, called phases. The length of

each phase may vary based on the intensity of the

treatments and other factors.



The first phase of ALL treatment is called

induction. This phase may also be called by

other names such as remission induction or

induction therapy. The goal of induction therapy

is to kill as many leukemia cells as possible.

It is meant to cause (induce) a remission. A

remission is when no leukemia cells can be

seen in blood or bone marrow viewed with a

microscope and blood cell counts are back to


The induction phase often lasts about four

weeks (one month). You may need to stay in

the hospital for some or most of this time.

CNS prevention and treatment

is started

during induction. It is given throughout all

phases of ALL treatment. This part of treatment

is also referred to as CNS prophylaxis. CNS

treatment is given to keep ALL from spreading

to the area around the brain and spinal cord.

When leukemia cells are found in this area, it is

called CNS disease.



The second phase of ALL treatment is called

consolidation. This phase may also be called

by other names such as intensification or

postremission consolidation. Consolidation

therapy is given once ALL is in remission.

The goal of consolidation therapy is to kill any

leukemia cells that may still be in your body.

During this phase, treatments are intensified.

This means that drugs are given in higher

doses than during induction. The consolidation

phase often lasts for a few months.



The third phase of ALL treatment is called

maintenance. The goal of maintenance

therapy is to keep ALL from coming back.

Most maintenance drugs are given orally, and

patients are usually treated in an outpatient

setting. The lower doses tend to have less

severe side effects. The maintenance phase

lasts about two to three years. Consolidation

and maintenance are often jointly called

postremission therapy. Postremission therapy

refers to any treatments given after ALL is in

complete remission.