Treatment for adult B-cell acute lymphoblastic leukaemia (B-ALL)

• Because B-ALL can develop quickly, your hospital team will want to begin treatment as soon as possible.
• Treatment for B-ALL usually takes around two to three years.
• Your treatment plan will be individual to you, and will depend on different factors.
• You may have the opportunity to have your treatment as part of a clinical trial.
• You will need to spend time in hospital as an inpatient, particularly in the first few weeks and months.
• There will be times where you'll be more at risk of infection.
• B-ALL treatment can cause side effects. We have information about side effects of B-ALL treatment.

The first phase of treatment for B-ALL is called “remission induction”. It usually lasts between four weeks and two months, but your hospital team will be able to give you a better idea of how long it might take for you individually.

You'll be given steroids and a mixture of chemotherapy drugs, which work in different ways to destroy the leukaemia cells inside your blood and bone marrow and get you into remission. This works for about 90% of people. You may also receive other types of treatment.

Because there’s a risk of infection or bleeding, you are likely to spend all, or most, of this stage in hospital, under the care of your hospital team.

Remission induction treatment for B-ALL can include:

Steroids

You will usually be given a corticosteroid (often just called a steroid) early on into your treatment. This is a very important part of treatment. These steroids will start working to destroy the leukaemia cells. This initial period is sometimes called the “steroid pre-phase.”

You’ll likely continue to receive steroids throughout your treatment. Common steroids used include

• dexamethasone
• prednisolone.

You might notice side effects like feeling more hungry, weight gain and changes to your sleep when taking steroids. Another side effect you might have is changes to your mood. There might be times where you feel tearful or irritable.

If you notice any side effects, speak to your hospital team, as they can provide support and advice.

Chemotherapy

Most chemotherapy for B-ALL is given by intravenous infusion. This is where chemotherapy drugs are delivered straight into your bloodstream through a vein using a cannula or a central line. A cannula is a small tube put into a vein in your arm or hand. A central line is a long, thin tube that's put into a vein in your arm or chest and stays in place all through your treatment.

Depending on your treatment plan, you will be given a combination of chemotherapy drugs. Chemotherapy drugs which are commonly used for remission induction for B-ALL include:

• daunorubicin
• vincristine
• doxorubicin
• asparaginase.

Intrathecal chemotherapy
Some people diagnosed with B-ALL have leukaemia cells in their central nervous system. This means that leukaemia cells have been found in the fluid around their brain and spinal cord. This fluid is called the cerebrospinal fluid (CSF).

Throughout your treatment for B-ALL, you will likely receive injections of a chemotherapy drug called methotrexate directly into your CSF. This type of treatment is called intrathecal chemotherapy.

The aim of this treatment is to destroy any leukaemia cells that are in the CSF, as well as stop any leukaemia cells from entering this fluid in the future.

How often you will receive intrathecal chemotherapy and when you receive it will depend on:

• whether any leukaemia cells are found in your central nervous system (if there are, you’ll likely need intrathecal chemotherapy more often.
• your individual treatment plan (protocol).

Your hospital team will be able to give you an idea of how often you’ll need this type of treatment.

Monoclonal antibodies (mAbs)

Monoclonal antibodies work by attaching themselves to specific proteins or genetic changes on the surface of leukaemia cells. This makes it easier for your immune system to find these leukaemia cells and destroy them. Research and clinical trials have shown that these drugs can hugely improve outcomes for people with specific types of B-ALL.

Because monoclonal antibodies are a targeted treatment, they generally cause less side effects than chemotherapy. However, like all cancer treatments, they can still cause side effects, and these can vary from person to person. Your hospital team will tell you the side effects to look out for.

Rituximab

A common type of protein found on the leukaemia cells of people with B-ALL is the CD20 protein. If you have this, your treatment plan will likely include a type of monoclonal antibody called rituximab, which targets the CD20 protein. It is usually given as intravenous infusion, which means it is injected into your blood through a vein.

Different monoclonal antibodies are given in different ways. Whether you receive monoclonal antibodies, which ones you receive and when you receive them, will depend on your individual treatment plan. Your hospital team will be able to give you more information.

Tyrosine kinase inhibitors (TKIs)

If you have Philadelphia positive B-ALL, you will be given a type of targeted treatment called a tyrosine kinase inhibitor (TKI)

People with Philadelphia positive B-ALL have an abnormal protein in their leukaemia cells called BCR-ABL1. This protein acts as a tyrosine kinase, which is an enzyme that sends constant signals to the leukaemia cells, telling them to multiply. Tyrosine kinase inhibitors (TKIs) are a type of targeted treatment that work by blocking the signals sent out by the tyrosine kinase protein.

TKIs are tablets that you take by mouth. Your hospital team will tell you exactly how often to take your TKI and when.

TKIs have been found to hugely improve treatment outcomes for people with Philadelphia positive B-ALL.

After your remission induction treatment, doctors will look at samples of your blood and bone marrow under a microscope. This is to see how well your treatment has worked. If no leukaemia cells can be seen, it means you’re in remission.

Minimal residual disease test (MRD)

A minimal residual disease test (MRD), also called a “measurable residual disease” test, can give your doctor more information about how deep your remission is. This is a very sensitive test which measures the number of leukaemia cells in a sample of your bone marrow. It can find extremely small numbers of leukaemia cells that cannot be seen through a normal microscope.

Measuring the number of these cells left in your blood or bone marrow helps your doctor understand the risk of your B-ALL coming back (relapsing).

• If you are MRD-positive, it means that there are still some leukaemia cells left in your blood or bone marrow.
• If you are MRD-negative, it means that no leukaemia cells have been detected in your blood or bone marrow.

This test is really important in treating B-ALL, because it helps your doctor create a more individual treatment plan for you. The results of this test gives your doctor a good idea of how well your treatment is working to get rid of the leukaemia cells and therefore, how your B-ALL might respond to further treatment.

It also helps your doctor decide the right drug doses for you, so you don’t receive higher doses or more treatment than you need.

After your remission induction treatment, there may still be leukaemia cells in your blood and bone marrow, even if you are MRD negative.

You’ll therefore have more treatment to get rid of the leukaemia cells left in your blood and bone marrow and reduce the risk of the B-ALL coming back (relapsing). This is called the “consolidation” phase.

This phase of treatment usually takes about three to four months, but it can be different for everyone and will depend on your treatment plan.

This phase of treatment usually takes about three to four months, but it will depend on your individual treatment plan. You will need to go into hospital regularly for your treatment, blood tests and check ups, but you will often be able go home afterwards, rather than having to stay overnight.

You may still need to spend quite a bit of time in hospital during this phase of treatment, for example, if you develop severe side effects or you get an infection.

Your treatment plan for the consolidation phase of treatment will be individual to you and will aim to give you the best chance of preventing the B-ALL from coming back (relapsing).

Your doctor will decide which treatments are right for you by looking at

• your MRD test results
• the genetic features of your leukaemia cells
• how well your body has been coping with treatment so far.

Your doctor may make changes to your treatment plan throughout your consolidation treatment, depending on how well your treatment is working and how well your body is coping with the treatment.

Consolidation treatment for B-ALL can include:

Chemotherapy drugs

You will receive a combination of chemotherapy drugs in cycles (blocks), over several months. What drugs you have, and when, will depend on your treatment plan.

Chemotherapy drugs you may receive during your consolidation phase of treatment include:

• methotrexate
• cyclophosphamide
• mercaptopurine
• cytarabine
• asparaginase
• vincristine
• daunorubicin or doxorubicin.

Steroids

You may be given steroids during your consolidation treatment to help get rid of any leukaemia cells left in your bone marrow.

Unless you have Ph+ B-ALL, it’s very likely that you will be given a drug called blinatumomab at some stage during the consolidation phase of treatment.

If no leukaemia cells have been found in your bone marrow after your remission induction treatment (you are MRD negative), you will be given blinatumomab to help keep you in remission and reduce the risk of the B-ALL coming back (relapsing).

If there are still some leukaemia cells found in your bone marrow (you’re MRD-positive) after your remission induction treatment, you will be given blinatumomab to help get rid of these remaining leukaemia cells. This will be to try to reduce the risk of the B-ALL coming back (relapsing). You might have blinatumomab to keep the B-ALL under control while you get ready for a stem cell transplant. You might hear this called a “bridge” treatment.

How does it work?

Blinatumomab is a type of immunotherapy treatment, which means it uses a person’s own immune system to kill cancer cells. This drug targets the CD19 protein, which is found on the surface of the leukaemia cells of over 90% of people with B-ALL. Blinatumomab is in the same family as monoclonal antibodies but works a bit differently.

It works in two parts. One part of the drug attaches to the CD19 protein on the leukaemia cell, and the other part, attaches to your T-cells, a type of infection-killing blood cell that’s part of your immune system. This brings your T-cells into contact with the leukaemia cells, so the T-cell can destroy them.

How is it given?

Blinatumomab is usually given as a continuous infusion into your blood, through a small pump that you can carry around with you in a bag or a belt. A cycle is 28 days, followed by a two-week break. You usually start the treatment in hospital so that your hospital team can keep an eye on you and how you’re coping with the treatment, but most people can go home with the pump after a few days.

Different monoclonal antibodies are given in different ways. Whether you receive monoclonal antibodies, which ones you receive and when you receive them, will depend on your individual treatment plan. Your hospital team will be able to give you more information.

If you have Philadelphia positive B-ALL, you will likely continue to receive a TKI throughout the consolidation phase of your treatment.

You might be told by your hospital team that you need a stem cell transplant as part of your consolidation treatment. A stem cell transplant aims to completely replace your immune system and your bone marrow, with healthy stem cells from another person (a donor), so they can work normally again. This type of treatment might be needed to give you the best chance of staying in remission, if your leukaemia is at a higher risk of coming back (relapsing).

A stem cell transplant is a very intensive type of treatment which comes with risk of complications. Stem cell transplants are only recommended for people who are fit enough, and when the possible benefits outweigh the risks. In other words, if your doctor thinks there's a higher chance of a stem cell transplant curing you, than causing you serious harm.

Your hospital team will consider your general fitness, your age, your type of B-ALL and how well the first phase of your treatment worked.

Before your stem cell transplant, you will have conditioning therapy. This gets your body ready for the stem cell transplant. It makes space in the bone marrow for the healthy stem cells from your donor and suppresses your immune system to stop your body from fighting the new donor cells. Depending on how intensive your treatment plan (protocol) is, the conditioning therapy might also aim to kill any remaining leukaemia cells in your bone marrow.

The main type of treatment used for conditioning therapy is chemotherapy. Some people have other types of treatment as well, including radiotherapy.

After your conditioning treatment has prepared your body, healthy stem cells from your donor will then be given to you through a vein. The aim is that these healthy donor stem cells will settle (engraft) in your bone marrow, where they will produce new, healthy blood cells.

You will likely have to stay in hospital for at least a few weeks after you’ve been given your donor stem cells. This is to make sure the process is working as it should, and that your bone marrow is starting to produce new blood cells. You’re at high risk of infection during this time so you will likely be in isolation.

After a stem cell transplant

If you have a stem cell transplant, you will have follow-up appointments once you have left hospital, likely for the rest of your life. These appointments are really important, as they will check for signs of relapse and monitor you for any late effects you may experience.

If you have a stem cell transplant as part of your consolidation treatment, you will not have the next phase of treatment (maintenance). You may however, still need further treatment after your transplant to give you the best chance of staying in remission.

If you have Philadelphia positive B-ALL, you will likely still need to receive tkis as part of your ongoing care.

Your doctor will talk to you about what your treatment plan and follow-up care will involve.

You can order a free booklet about allogeneic (donor) stem cell transplants.

Once you have finished the consolidation phase of treatment and you are in remission, you will have a phase of treatment called ''maintenance''. This phase of treatment lasts for around two years.

You won't have maintenance treatment if you had a stem cell transplant as part of your treatment.

You can think of your follow-up care as starting during this maintenance phase. Most people will be able to start getting back into their usual routines and doing things they enjoy, like going back to work or college, travelling or going on holiday.

You may find it useful to read our information about life in remission for B-ALL.

The goal of the maintenance phase treatment is to prevent the B-ALL from coming back (relapsing) while allowing you to return to your daily life. Many people find that they can regain a sense of normality during this phase of treatment, often returning to college or work and getting back to the activities they enjoy.

Maintenance treatment usually lasts up to two years, but the exact length can differ from person to person and will depend on you individually and your treatment plan.

During your maintenance treatment, you’ll still have chemotherapy, but it will be less intensive than your earlier phases of treatment.

Depending on your treatment plan, you may also have other types of treatment during your maintenance phase, including

• steroids
• intrathecal chemotherapy
• targeted treatments.

If you have Philadelphia positive B-ALL, you will likely need to continue to take TKIs throughout your maintenance phase of treatment. This is to help reduce the risk of the B-ALL coming back (relapsing).

The treatment you will have during your maintenance phase for B-ALL, will depend on things like:

• your age
• the type of B-ALL you have and the genetic changes in your leukaemia cells
• how well your treatment has worked so far
• which treatment plan (protocol) you are on.

Your hospital team will be able to give you more information about what the maintenance phase of treatment will look like for you and how they will monitor you.

The maintenance phase is really important because without it, there’s a higher chance that the B-ALL could come back, even if your tests show that you’re in full remission (you’re MRD negative). It is therefore really important that you take your medication every day, exactly how your hospital team advises.

Maintenance treatment can be taken in tablet form, or given to you as an outpatient in hospital. So unless you get an infection or have any complications, you won’t need to stay in hospital.

You will likely have blood tests every one or two weeks, throughout your maintenance phase. This is so that your doctor can make any changes to your treatment and doses that might be needed, but also to make sure that the B-ALL isn't coming back. It's therefore really important to make sure you go to every check-up and follow-up appointment you are invited to.

You may receive these blood tests at your treatment hospital. You might be able to have them at a local hospital, if it's more convenient for you, and your treatment team agrees.

If you are on maintenance treatment, you will likely need to take different medications on different days. Taking your treatments exactly as your doctor tells you is very important. Find something that works for you to help you with this. People who have been through maintenance treatment have some tips that helped them:

• keep a chart (paper or digital) that clearly shows which drugs are taken on which days.
• set alarms which alert you when you need to take certain medicines
• organise your medications at the beginning of each week, placing each day’s doses into a pill box with clearly labelled compartments
• have a loved one who also knows your treatment schedule
• set a regular time to collect your medication and always making sure you have enough supply at home
• talk to your hospital team if you're struggling with side effects, so they know how best to support you.

Why not join our Online Community Forum and connect with others who are going through or who have been through, the maintenance phase of B-ALL treatment.

This information has been accredited with the PIF TICK, the UK's only quality mark for trusted health information.

Last full review June 2026. Next full review due June 2029. We may make factual updates between reviews.

Thank you to Consultant Haematologists Professor Adele Fielding and Dr Clare Rowntree for checking the clinical accuracy of our adult B-cell acute lymphoblastic leukaemia (B-ALL) information.

Thank you also to Karis, Ricky, Binu, Harry, Keri and Jesús for sharing their experiences and for helping with the creation of this information.