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Chemotherapy (chemo) is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. Most chemo drugs don't reach the area around the brain and spinal cord, so the drugs may also need to be put right into the cerebrospinal fluid to kill cancer cells in that area.

Chemo is the main treatment for acute lymphocytic leukemia (ALL). It generally means getting several drugs over a long period of time (often about 2 years). Treatment is separated into three phases.

Remission induction (sometimes just called induction)

The purpose of the first phase is to bring about a remission. A remission means leukemia cells are no longer found in bone marrow samples, even after the normal marrow cells return and the blood counts become normal. But this is not the same as a cure, as leukemia cells are likely to still be hiding somewhere in the body.

You will get more than one chemo drug and the doses are often high. If the ALL cells have a certain gene change, a targeted therapy drug is a part of treatment. You will most likely also have chemo put right into the spinal fluid to treat leukemia in the area around the brain and spinal cord or to keep the leukemia cells from spreading there.

Treatment in this phase can often have serious side effects, including life-threatening infections. For this reason, the doctor will watch you closely and prescribe drugs like antibiotics if needed. You may spend some or much of this time in the hospital.

If the leukemia doesn’t go into remission with the first round of chemo, another round of intensive chemo will be given.


After the leukemia goes into remission, the next phase is often a treatment over the next few months with chemo (sometimes with targeted therapy) using many of the same drugs that were used before. This may also include chemo into the spinal fluid. This treatment phase is often easier to take than induction.

Doctors may suggest a stem cell transplant (SCT) for patients who are at a high risk of the leukemia coming back. If you will need SCT, think about having it done as part of a clinical trial at a center that has done a lot of SCT procedures. See "Stem cell transplant for acute lymphocytic leukemia" for more details


The last phase of treatment, called maintenance, is meant to help keep the leukemia from coming back. It uses lower doses of chemo drugs given over about 2 years. For people whose ALL cells have a certain gene change, maintenance often includes a targeted therapy drug. Chemo may also continue to be given into the spinal fluid.

Side effects of chemo

Chemo drugs kill fast-growing cells such as cancer cells, but in the process they also damage other normal cells that grow fast.

The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Common side effects might include:

  • Hair loss
  • Mouth sores
  • Higher risk of infection (from low white blood cells)
  • Easy bruising or bleeding (from low blood platelets)
  • Tiredness (from low red blood cells)
  • Loss of appetite
  • Nausea
  • Vomiting
  • Diarrhea

Most side effects usually go away after treatment ends. Be sure to talk to your doctor if you are having trouble with side effects because there are often ways to manage them during treatment. For example, there are drugs that can be taken along with the chemo to help prevent or reduce nausea and vomiting. Drugs called growth factors are sometimes given to keep your blood counts higher and reduce the chance of infection.

Chemo for ALL can damage kidneys, liver, testicles, ovaries, brain, heart, and lungs. Your doctor will watch you carefully to try to prevent much of the damage. If serious side effects happen, the drugs may have to be reduced or stopped. Be sure to tell your doctor about any problems you have. .

Last Medical Review: 12/08/2014
Last Revised: 02/22/2016