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Treatment and the treatment process

Induction

Induction is the first and most intensive phase of treatment for acute leukemia. This topic explains its goal, how it goes and what to be prepared for.

Last updated: ~2 min read
A teal wave of light sweeps grey blasts from a bone marrow landscape, leaving small golden healthy cells.
Figure 1.Induction clears the marrow of leukemia cells.

01Short answer

The goal of induction is to reduce leukemia cells enough for normal blood production to return in the bone marrow — that is, to reach remission. In AML this is usually the "7+3" course: 7 days of cytarabine and 3 days of an anthracycline (with a targeted drug if needed); in ALL it is 4–6 weeks of a steroid, vincristine, asparaginase and sometimes an anthracycline, plus drugs into the spinal fluid. After the course, blood counts fall sharply; during this time transfusions, infection prevention and urgent antibiotics for fever are essential. After about 4–6 weeks the bone marrow is checked; sometimes a second induction course is needed.

02Simple explanation

Goal. Reduce leukemia cells as much as possible.

How? Several strong drugs together.

Where? Usually in hospital, for several weeks.

Then. The marrow is checked — is there remission?

03Scientific explanation

Principle: combining drugs with different mechanisms prevents resistance and reduces the leukemia burden by more than 99%, but hidden residual cells may remain — which is why consolidation is needed (NCI).

Assessing remission: complete remission means marrow blasts <5%, neutrophils ≥1.0×10⁹/L, platelets ≥100×10⁹/L and no leukemia outside the marrow. An MRD test shows how deep the remission is.

Complications: febrile neutropenia, inflammation of the mucous membranes (mucositis), tumour lysis syndrome, asparaginase-related clots and pancreatitis, and strain on the heart from anthracyclines. Teams watch for these with prevention and regular tests.

04What happens in the body?

The first days

A central venous catheter is often placed so that drugs can be given and blood taken without a new needle each time. Plenty of fluids and special medicines are given to prevent tumour lysis.

The low-count period

About a week after the course, blood counts reach their lowest point and may stay there for 2–4 weeks. During this time a fever is an emergency. As counts recover, strength returns.

A line of light on a dark background dipping into a deep valley and rising to a warm horizon.
Figure 2.After the course, blood counts fall and then recover.

Checking the result

At the end of induction a bone marrow test is done. If there is remission, consolidation begins. If not, the doctor may offer a second course or a different treatment.

A microscope by a window with dawn light and a small calendar page.
Figure 3.The marrow is checked at the end of induction.

05How induction goes

A simplified outline.

Preparation — Catheter and tests.1PreparationCatheter and tests.
Course — Several days or weeks.2CourseSeveral days or weeks.
Low counts — Support and protection.3Low countsSupport and protection.
Check — Bone marrow.4CheckBone marrow.
RemissionThe goal.
MRDDepth of response.
TeamRound-the-clock care.

06Induction in AML and ALL (simplified)

AMLALL
Typical drugsCytarabine + anthracycline ("7+3")Steroid, vincristine, asparaginase ± anthracycline
Length7-day course, then recovery4–6 weeks
Targeted add-onFLT3 inhibitor, gemtuzumabTKI if Ph+
CNS preventionUsually notEssential, intrathecal
HospitalOften 3–5 weeksPartly, by protocol
CheckBone marrow, MRDBone marrow, MRD

* Protocols differ; your doctor sets your plan.

07Key terms

Induction
The first treatment to reach remission.
Remission
Signs of leukemia disappearing.
Neutropenia
A shortage of neutrophils.
Febrile neutropenia
Fever during neutropenia — an emergency.
Mucositis
Inflammation of the mouth and gut lining.
Central venous catheter
A long tube placed in a large vein.

08Key points

  • The goal of induction is remission.
  • Drugs are given in combination.
  • Blood counts fall sharply for a time.
  • Fever is an emergency.
  • The marrow is checked at the end.
  • Consolidation follows remission.

09Frequently asked questions

Can I have visitors?

Healthy visitors are usually allowed; follow the hospital rules.

Will my hair fall out?

With many induction regimens, yes, usually temporarily.

What can I eat?

During neutropenia, follow food-safety rules (see topics “Handwashing: the simplest protection” and “Eggs and dairy: safe choices”).

Is a second course bad news?

Not always; some people reach remission after a second course.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Can I have visitors?

  2. Will my hair fall out?

  3. What can I eat?

  4. Is a second course bad news?

My questions

12Sources

  1. National Cancer Institute (NCI). Adult Acute Myeloid Leukemia Treatment (PDQ) – Patient Version
  2. National Cancer Institute (NCI). Adult Acute Lymphoblastic Leukemia Treatment (PDQ) – Patient Version
  3. National Cancer Institute (NCI). Chemotherapy to Treat Cancer
  4. American Cancer Society. How Chemotherapy Drugs Work
  5. Cancer Research UK. Chemotherapy
  6. Blood Cancer United (LLS). Acute myeloid leukemia (AML) treatment: phases of treatment
  7. ICUsteps. Guide to intensive care: how might I feel
  8. Critical Care, 2010. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial
  9. MedlinePlus. Chronic Kidney Disease
  10. NIDDK (NIH). Kidney Disease
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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