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Induction, consolidation and maintenance in childhood ALL | CION Cancer Clinics
Induction is about four weeks of intense treatment that aims to put your child's ALL into remission. Consolidation then clears the leukaemia cells too few to see and protects the brain and spine. Maintenance is the long, gentler phase of tablets at home, running until treatment reaches two to three years. Here is what each phase involves, what a normal week looks like, and when to act fast. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What are induction, consolidation and maintenance?
- What happens in each of the three phases?
- What happens at the end of induction?
- What is daily life like during maintenance?
- How are the intense phases different from maintenance?
- What do parents often misunderstand about these phases?
- Common questions about induction and maintenance
The short answer
What are induction, consolidation and maintenance?
They are the three core phases of treatment for childhood ALL (acute lymphoblastic leukaemia). Induction clears the leukaemia from the bone marrow, consolidation clears the cells left behind, and maintenance keeps them from growing back over a long, gentler stretch at home.
Each phase has a different feel
Induction is short and intense. Consolidation is steady, with many day-care visits. Maintenance is quiet and long, and for most of it your child can go to school, play and eat normally. Knowing which phase you are in helps you know what a normal week looks like.
There may be more blocks in between
Many protocols, the written plans that treatment follows, add a calmer interim maintenance and a second intense block called delayed intensification before maintenance begins. Your child's plan will name each block and its dates. If a block on the plan is not described here, ask the team to explain it.
The phases work as a set
No single phase does the job on its own. The first month can make the leukaemia invisible, but only the full course keeps it away. That is why every phase matters, including the quiet ones. This page cannot tell you how your own child will respond or what the outlook is. Those answers come from your child's test results, read by the haematologist who knows the full picture.
Phase by phase
What happens in each of the three phases?
Typical patterns only. Your child's protocol sets the medicines, timings and number of visits.
Induction
About four weeks of steroids and chemotherapy, given into a vein, by mouth, and into the spinal fluid. The aim is remission, meaning no leukaemia is seen in the bone marrow.
Medicines you may hear named
- Dexamethasone or prednisolone
- Vincristine
- Asparaginase
Consolidation
Treatment continues to reach cells too few to see. It also protects the brain and spine with repeated lumbar punctures, where medicine is given through a thin needle in the lower back.
Medicines you may hear named
- Methotrexate
- Mercaptopurine
- Cyclophosphamide
Maintenance
The longest phase. Your child takes tablets at home, has regular blood tests, and may have short steroid courses and occasional lumbar punctures. Doses are adjusted by the team using the blood counts.
Maintenance usually runs until the whole treatment reaches two to three years.Not sure whether this applies to you?
Ask an oncologistThe first milestone
What happens at the end of induction?
A bone marrow test
A small sample of marrow is taken from the hip bone, usually with your child sedated. It shows whether the leukaemia has gone into remission, which is the goal of this first phase.
The MRD result
MRD (minimal residual disease) is a sensitive test for leukaemia cells too few to see under a microscope. It is one of the strongest guides to what comes next, and the lab may take some days to report it.
The risk group is confirmed
The team puts together the MRD result, the type of ALL and the changes found in the cells. Your child may stay in the same risk group, or move to a lighter or stronger plan.
The next phase is explained
You should get the dates and the medicines for consolidation. Ask what changed and why, and write down which visits are day-care and which may need a stay.
!
One thing that cannot wait, in any phase
A fever, shivering, or your child suddenly becoming floppy or very drowsy during treatment is an emergency. Go to the nearest emergency department the same day, or call 108, and say your child is on leukaemia treatment. Do not give fever medicine and wait for the morning. It can hide a serious infection that needs treatment within hours.
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The long stretch
What is daily life like during maintenance?
For most families, maintenance is when life starts to feel normal again. Your child takes tablets at home, comes to clinic for regular blood tests, and in most cases goes back to school.
The tablets are real treatment
The daily tablets are what keep the leukaemia from returning. Give them as the team has told you, at the same time each day. If your child vomits a dose, misses one, or refuses to swallow, call the team and ask. Never skip, stop or change a dose on your own.
Why the dose keeps changing
The team reads your child's blood counts at each visit and adjusts the tablets to keep the counts in a safe range. A change does not mean something has gone wrong. It is how maintenance is meant to work.
Who it is harder for
Maintenance is tougher for teenagers who are tired of treatment, and for families who live far from the clinic. Tell the team early if travel, school or tablets are becoming a struggle. There is usually a way to make it easier.
Keep a simple chart at home of each tablet given. It helps at every clinic visit.Side by side
How are the intense phases different from maintenance?
Induction and consolidation
Maintenance
Several medicines, many given in hospital
Mainly tablets taken at home
Frequent visits and sometimes a hospital stay
Regular clinic checks, spaced further apart
Counts often low, so infections are a bigger risk
Counts kept steady, though fever still needs urgent care
School usually paused
Most children back at school
Steroid mood and appetite changes common
Shorter steroid courses, if any
Commonly believed
What do parents often misunderstand about these phases?
"The report says remission, so the leukaemia is gone."
Remission after induction means leukaemia cannot be seen by the usual tests. Cells too few to see are still there. That is exactly why consolidation and maintenance follow, and why they should not be cut short.
"Our child feels well now, so maintenance can be skipped."
Feeling well is the point of maintenance, not a sign it is finished. Stopping early raises the chance the leukaemia comes back. Any change to the plan should come from the treating team.
"The steroids have changed our child for good."
Steroids can bring anger, tears, big hunger and poor sleep, which is hard for everyone at home. These changes usually settle once the course ends. Tell the team if they are severe.
"Herbal or home remedies will make the tablets work better."
Some remedies can change how chemotherapy works or affect the liver. Tell the team about anything you plan to give, including tonics and supplements, before you start it.
Questions we are asked
Common questions about induction and maintenance
How long does induction last for a child with ALL?
Usually about four weeks. It is the most intense stretch of treatment, and your child may need a hospital stay at the start. At the end, a bone marrow test checks whether the leukaemia has gone into remission. Your child's protocol sets the exact length, so ask the team for the dates.
What if my child is not in remission after induction?
It happens to a small number of children, and it does not mean nothing can be done. The team will usually move to a stronger plan and may discuss further options. Ask your child's haematologist what the result means and what the next step is for your child specifically.
How long is maintenance?
Maintenance continues until the whole treatment reaches its planned end, usually two to three years from the start. That makes it the longest phase by far. The exact end date depends on your child's protocol, and the team will tell you when to expect it.
Can we give maintenance tablets with milk?
Some maintenance tablets are affected by milk and food, so timing matters. Ask the team exactly how and when your child should take each tablet, and write it down. Do not change the time or method on your own, even if a relative suggests it.
Will my child lose their hair in every phase?
Hair loss is common in the intense phases. It usually grows back during maintenance, sometimes a slightly different colour or texture. It is hard for many children, especially older ones. A cap or scarf, and telling classmates in advance, can make it easier.
Can my child get vaccines during treatment?
Live vaccines are usually avoided during treatment, and some others may not work well. Do not give any vaccine without asking the team first. Brothers and sisters may still need theirs, so ask about the family too. The team will plan catch-up vaccines once treatment ends.
Can CION give this treatment?
CION's haematology team reviews your child's reports, presents the case at a tumour board and helps coordinate care with qualified paediatric centres where specialised treatment is needed. Bring every report and your child's treatment plan, and ask which phase your child is in.
Is treatment covered by Aarogyasri or insurance?
Childhood leukaemia treatment is often covered under Aarogyasri, PM-JAY, CGHS, ECHS, EHS or cashless insurance, but entitlements and limits change. Check the current rules for your card before each phase starts. Our helpline can help you understand what your scheme may cover.
Your Haematologist
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- National Cancer Institute — Childhood Acute Lymphoblastic Leukemia Treatment (PDQ) - Patient Version
- American Cancer Society — Treatment of Children With Acute Lymphocytic Leukemia (ALL)
- Cancer.Net — Leukemia - Acute Lymphoblastic - ALL - Childhood
- Leukemia & Lymphoma Society — Acute Lymphoblastic Leukemia (ALL)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
ALL Treatment Phases in ChildrenThe whole road map from diagnosis to follow-upMRD in Childhood LeukaemiaThe test at the end of induction, explainedThe Long Maintenance Phase: Two Years at HomeMore on daily tablets, school and clinic checksSteroids and Behaviour Changes in ChildrenCoping with mood and appetite changes at homeLumbar Punctures and Intrathecal Chemotherapy in ChildrenWhat happens at each spinal fluid procedure
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