During and after acute lymphoblastic leukaemia (ALL) treatment
Your healthcare team will talk to you about things you need to be aware of during and after treatment.
It is important to look after yourself during and after treatment for acute lymphoblastic leukaemia (ALL). You may have some side effects that take weeks or months to improve, especially after intensive treatment. Your doctor and specialist nurse will give you advice to help you recover and to prevent complications. They can also tell you about support available in your area and ways to look after your general well-being and long-term health.
When your blood counts recover, you can usually eat and drink a normal diet. Eating a healthy, balanced diet and keeping to a healthy weight may help to:
- increase your energy levels
- improve your sense of well-being
- reduce the risk of new cancers, heart disease, stroke and diabetes.
Having treatment can lower your immune system. This means that you are more likely to get an infection. Try to avoid possible risks of infection from food. Here are some tips that might help:
- eat freshly cooked food
- avoid reheating food
- make sure that frozen foods are completely defrosted before cooking
- wash salads and fruit well.
Ask your doctor or specialist nurse for advice. They may give you a list of foods to avoid such as raw meat and fish, undercooked eggs and unpasteurised cheese.
If you drink alcohol, drinking a lot can slow down your recovery. It can increase the risk of bleeding, especially if your platelet count is low. Alcohol can also affect how some drugs work. Ask your doctor if it is okay for you to drink alcohol.
We have more information about healthy eating.
Usually there is no medical reason to stop having sex during treatment for leukaemia. You may feel less interested in sex if you feel tired or sick. These side effects will gradually improve when your treatment is finished.
Your doctor may advise you to avoid having sex when your platelets are low. If you have a higher risk of bleeding, your doctor may advise you to avoid penetrative sex.
You may also be advised to not have sex after having a stem cell transplant. You may not be able to have any close physical contact with anyone for a while. This is because you are more likely to get an infection, which can be dangerous. Your doctor can give you more information about this.
Drugs used to treat leukaemia can be harmful to an unborn baby. You should use contraception to prevent a pregnancy during your treatment and for at least 4 months after. Even if your treatment is likely to damage your fertility, you may still be able to get pregnant or make someone pregnant. Ask your doctor or specialist nurse for more information.
Leukaemia cannot be passed on during sex. However, small amounts of chemotherapy, or other drugs, may get into your bodily fluids. This includes vaginal fluid and the fluid that carries sperm (semen). To protect your partner, your doctor may advise that during your treatment you:
- use a condom or a latex barrier such as a dental dam for oral sex
- use a condom for vaginal or anal sex.
Using condoms and dental dams also helps protect you from sexually transmitted infections (STIs). This is important because your treatment may affect how your body fights infections
Your doctor may advise you to have vaccinations against common illnesses such as flu. If you live with other people, you doctor may also suggest that they have the flu vaccine and keep up with other regular vaccinations.
If you had a donor stem cell transplant, you will lose the effect of any vaccinations you had as a child. You will need to have these vaccinations again.
There are some types of vaccines that are not safe to have until your immune system recovers. These are called live vaccines. They include flu vaccines that are given as a spray up the nose. If you have young children, they should not have this type of flu vaccine. This is because it may affect you too. Ask your doctor or specialist nurse for advice about this or before you have any vaccinations yourself.
While your white blood cell levels are low, try to avoid crowded places such as cinemas, pubs and public transport. This may help reduce your risk of infections.
How quickly you get back to your full social life may depend on the treatment you had and how your blood cell levels recover. Your doctor or specialist nurse can give you advice and tell you what your full blood count is.
Avoid contact with people who have an infection such as chickenpox or measles. If you are worried you have had contact with someone with an infectious disease, contact your doctor or specialist nurse.
If you are planning to go on holiday, talk to your doctor. For the first few months after treatment, you may still have regular check-ups or clinic appointments at hospital. You may sometimes need blood or platelet transfusions.
If you had a stem cell transplant, it is best not to plan any holidays until at least 6 months after treatment has finished. Your doctor will usually advise you not to travel abroad in the first year after a transplant, unless there is a cancer treatment centre nearby.
Regular gentle activity is a good way to help build up energy levels. Walking is a good example of this. Exercise has also been shown to help reduce stress and anxiety.
You will have to be careful about exercising if your platelets are low. If you have low numbers of red blood cells (anaemia), you may feel very tired and sometimes breathless. Ask your doctor or nurse about what kind of exercise is suitable for you when your blood count is still recovering.
If you smoke, giving up is one of the healthiest decisions you can make. Smoking increases your risk of bone thinning (osteoporosis) and is a major risk factor for smoking-related cancers and heart disease.
Ask your doctor or nurse for advice if you are thinking about quitting. We have more information about giving up smoking.
Your doctor or nurse can give you advice about when to start work or study again. It may depend on the treatment you had and how well you are recovering. If you had a stem cell transplant, your doctor or specialist nurse may advise you to wait until your blood count has gone back to normal or almost normal.
When you are ready to go back to work or study, you may want to start part-time and build up gradually. Talk to your employer, teacher or tutor about your plans for returning to work or study. There may be ways they can help.
You can also ask them to talk to the people you work or study with about your illness and treatment before you return. Check that you feel comfortable about the way they plan to do this. We have more information about returning to work.
Leukaemia and its treatment can have a big impact on your life. There may be times when it is all you think about. It can also feel like you have little control over many of the things that are happening.
You may find you want things to be as normal as possible. This can involve staying in contact with friends and doing your usual activities. Or you may decide different things are important to you now and want to make changes.
Find more support
Talk to your doctor, specialist nurse or one of our cancer support specialists about other support that may be available. They may help you find more practical advice, medical information, emotional support or spiritual comfort.
Get the most out of meetings with your medical team
Before you meet, think about questions you want to ask or things that are worrying you. Write your questions down when you think of them, so that you can bring the list to your meeting. Some people find it helps to have a friend or family member in the meeting with them. Your doctor or specialist nurse will usually be able to answer your questions.
Take medications as prescribed
This might be treatment for the leukaemia, or medicines that prevent or reduce symptoms and side effects of treatment.
Find someone to talk to
It can help to share how you are feeling and what is on your mind. There may be a few people you can talk openly to and ask anything. They could be family, friends or colleagues, or someone from a local carers’ or cancer support group.
Find ways to relax
Different things work for different people. Taking time to relax can help you cope with stress and anxiety. We have information about complementary therapies if you find these useful. Remember some complementary therapies may not be suitable if you have leukaemia or are having treatment for leukaemia. It is important to talk to your doctor or specialist nurse before you have any complementary therapy. It is also important to tell your complementary therapist that you have leukaemia.
Below is a sample of the sources used in our acute lymphoblastic leukaemia (ALL) information. If you would like more information about the sources we use, please contact us at email@example.com
Hoelzer D, et al. Acute lymphoblastic leukaemia: ESMO clinical practice guidelines. Annals of Oncology. 2016. 27 (Supplement 5): v69-v82.
National Institute for Health and Care Excellence. Blood and bone marrow cancer. www.nice.org.uk/guidance/topic/conditions-and-diseases/blood-and-immune-system-conditions/blood-and-bone-marrow-cancers (accessed July 2018).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.
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