NCCN Guidelines for Patients
Acute Lymphoblastic Leukemia, Version 1.2017
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
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
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