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Acute Lymphoblastic Leukaemia — Parent Guide
ALL treatment in children — induction, consolidation & maintenance
Medically reviewed by the CION Paediatric Oncology Team · Last reviewed June 2026
Your child has been diagnosed with ALL leukemia. That sentence is terrifying. This page explains what the treatment actually involves — the three phases, what each one does, and what daily life looks like over a two-to-three year course — so you can walk into appointments with real questions.
- Three-phase ALL chemo protocol — induction, consolidation, and maintenance explained in plain language
- Tumour board for every child — haematologist, paediatric oncologist, and radiation oncologist together from Day 1
- 45-minute consultations — no rushed answers, every question welcomed
- Transparent treatment roadmap — you will know what is happening at every step before it happens
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Understanding the diagnosis
What is ALL leukemia — and why do children respond so well to treatment?
ALL stands for Acute Lymphoblastic Leukaemia. It is the most common cancer diagnosed in children. That fact, while frightening to read, also comes with something important: childhood ALL is one of the most treatable cancers in oncology today.
ALL begins in the bone marrow — the soft tissue inside your bones that makes blood cells. In ALL, immature white blood cells called lymphoblasts multiply out of control. They crowd out the normal red cells that carry oxygen, normal white cells that fight infection, and platelets that stop bleeding. This is why children with ALL often feel very tired, bruise easily, and pick up infections more frequently before diagnosis.
Unlike a solid tumour that sits in one place, ALL is a systemic disease — it is already present throughout the bloodstream and bone marrow at diagnosis. This sounds alarming, but it also means treatment is the same approach wherever you are: medicines that travel through the bloodstream reach the leukaemia cells wherever they are hiding.
The biology of childhood ALL is fundamentally different from adult leukaemia. Children's leukaemia cells often carry genetic features that make them more sensitive to treatment. This is why the outcomes for childhood ALL differ so markedly from the adult disease, and why paediatric oncologists treat it with different protocols designed specifically for developing bodies.
The first question most parents ask is: "Will my child be okay?" We cannot make promises, and we will not. What we can tell you is that childhood ALL is the cancer where modern oncology has made the most progress over the past 50 years. A diagnosis is the beginning of a difficult journey — not the end of your child's story. We walk this journey with you.
ALL chemo protocol
The three leukemia treatment phases — what each one does
ALL treatment follows a structured, internationally recognised protocol with three distinct phases. Each phase has a different goal, a different intensity, and a different effect on daily life. Understanding them helps you plan and reduces uncertainty at each transition.
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Phase 1 · Weeks 1–6
Induction — bringing the leukaemia under control
Induction is the most intensive period of treatment. The goal is to achieve remission — reducing the number of leukaemia cells in the bone marrow to levels that standard tests cannot detect. Treatment is usually given as an inpatient or in a day-care oncology unit, with very frequent blood count checks. Your child will likely feel most unwell during this phase because the medicines work hard on the marrow. Infections are a real risk; the care team will teach you exactly which symptoms require a same-day call or emergency visit. By the end of induction — typically four to six weeks — most children with ALL achieve remission. Remission is not the end of treatment; it is the beginning.
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Phase 2 · Several months
Consolidation — reinforcing remission and clearing hidden cells
Even when standard bone marrow tests show no leukaemia, some leukaemia cells can survive in very small numbers — too few to detect but enough to cause a relapse if treatment stopped. Consolidation (sometimes called intensification) delivers several further cycles of chemotherapy to target these residual cells. The approach in this phase also focuses specifically on protecting the central nervous system (CNS): medicine is delivered directly into the spinal fluid via lumbar puncture to prevent leukaemia cells from hiding in the brain or spinal cord. Consolidation is intermittent — cycles of treatment alternating with rest periods — so many children can spend time at home between hospital visits. Energy and appetite begin to return in the gaps.
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Phase 3 · ~2 years
Maintenance — sustaining remission over the long term
Maintenance is the longest phase, typically lasting around two years. The medicines used are far less intensive than induction or consolidation — most are given by mouth at home, with regular clinic visits for blood count checks and dose adjustments. Many children return to school and resume a near-normal routine during maintenance. The phase is not symptom-free: fatigue, mouth sores, and immune suppression continue, and the team will monitor counts carefully to avoid periods where infection risk becomes too high. Some children also receive periodic short bursts of a stronger regimen during maintenance — this is planned in advance and is not a sign things are going wrong. At the end of maintenance, the team will plan a structured schedule of follow-up checks.
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Monitoring & response assessment
How your child's care team tracks whether treatment is working
ALL treatment is not a fixed recipe applied the same way to every child. The care team continually reassesses your child's response and adjusts intensity accordingly. Here are the key monitoring tools they use.
Full Blood Count (CBC)
A blood sample taken at almost every clinic visit. It measures how many red cells, white cells, and platelets are circulating. During treatment, counts often fall — this is expected. The team uses trends to decide when to give the next cycle, hold a dose, or watch more closely.
Bone Marrow Assessment
Bone marrow is examined at specific points — typically at the end of induction and at planned intervals during consolidation. The sample shows what percentage of cells in the marrow are normal versus leukaemic, and whether remission has been achieved or maintained. Done under sedation; your child will not feel it.
Minimal Residual Disease (MRD) Testing
MRD tests use highly sensitive techniques to detect leukaemia cells at very low levels — down to one leukaemia cell among a million normal cells. A high MRD after induction may indicate the need for more intensive consolidation. A low or undetectable MRD is a positive sign and may allow a less intensive approach. Your oncologist will explain your child's MRD result in detail.
Spinal Fluid (CSF) Analysis
Each lumbar puncture provides a small sample of cerebrospinal fluid. This is checked for leukaemia cells to confirm the central nervous system remains protected. Medicine is delivered into the same space at the same visit, making the procedure diagnostic and therapeutic at once.
Organ Function Tests
Chemotherapy medicines work on rapidly dividing cells but can affect organs including the liver, kidneys, and heart. Regular blood tests check liver enzymes and kidney markers. Some children also have periodic heart scans (echocardiograms) to confirm normal cardiac function throughout treatment.
Tumour Board Review
At CION, every child's case is reviewed by a multidisciplinary tumour board — medical oncologist, haematologist, and radiation oncologist together. This is especially important at treatment transitions (end of induction, start of consolidation) or if MRD results are not as expected. Decisions for healing, not billing.
Life during treatment
What to expect at home — and how to support your child through it
A two-to-three year treatment course is a long time. Your family's ability to sustain this depends not just on medical decisions but on practical preparation and emotional support. Here is an honest picture of what life typically looks like at each stage.
During induction: This is the most demanding period. Your child may need to be admitted for monitoring during the first cycle. Hospital visits are frequent — sometimes daily for blood count checks. Expect significant fatigue, loss of appetite, and hair thinning. Infection is the most serious risk; a fever above 38°C during induction is a medical emergency and requires an immediate call to the oncology team. Siblings and visitors may be asked to keep away if they have colds or chickenpox exposure.
During consolidation: Treatment is delivered in cycles with rest gaps in between. On treatment days, the hospital visit may be several hours; on rest days, your child may feel much more like themselves. Appetite often improves between cycles. Many families use this phase to build predictable routines around clinic days. If your child is school age, speak to the oncology team about returning to school on good-count days — keeping some normality matters.
During maintenance: This phase feels very different. Most medicines are taken at home by mouth, on a weekly or daily schedule. Clinic visits reduce to once or twice a month. Many children return to school, resume sports within their energy limits, and look outwardly well. Underneath, the immune system is still suppressed, and the team remains watchful. Monthly blood tests allow dose adjustments. Some children experience steroid pulses during maintenance — short courses of high-dose steroids — which can cause mood swings, increased appetite, and sleep disruption for a week or two. These are planned, temporary, and expected.
After treatment ends: Follow-up visits continue for several years after the last dose of maintenance. The schedule varies by risk group but typically includes blood counts and bone marrow checks at regular intervals in the first two years, then reducing over time. Long-term effects of treatment — including effects on growth, bone health, and learning — are monitored proactively. A late effects clinic helps children transition into adulthood with the right information about their health.
You are not alone in this. CION's psycho-oncology team is available to support parents, siblings, and your child throughout treatment. You do not need to wait until a crisis to reach out — we encourage early, ongoing conversations.
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Common questions
Your questions about ALL treatment in children — answered
What is ALL and how is it different from other leukaemias?
ALL stands for Acute Lymphoblastic Leukaemia. It starts in immature lymphocyte cells inside the bone marrow — the cells that should grow into the white blood cells that fight infection. In ALL, these cells multiply rapidly but never mature, crowding out healthy red cells, normal white cells, and platelets. It is called “acute” because it progresses quickly. ALL is the most common cancer diagnosed in children, and it behaves very differently from the slower-growing leukaemias seen in adults. Because the bone marrow is the origin, ALL is a systemic (whole-body) disease from the start, not a solid tumour that spreads later. This means treatment focuses on clearing the whole bloodstream and marrow rather than removing a lump.
How long does ALL treatment take in children?
Total treatment for childhood ALL typically runs between two and three years. The first phase — induction — lasts approximately four to six weeks and aims to bring the disease into remission. Consolidation follows over several months and reinforces remission by targeting any remaining leukaemia cells. Maintenance, the longest phase, continues for roughly two years and uses lower-intensity medicines given largely at home. The exact duration depends on the risk group your child’s oncologist assigns based on age, white cell count at diagnosis, genetic features of the leukaemia cells, and how quickly remission is achieved. Your care team will give you a written timeline at the start of treatment.
What is "remission" and does it mean my child is cured?
Remission means that leukaemia cells are no longer detectable in the blood or bone marrow using standard tests. In childhood ALL, remission is usually achieved during the induction phase. However, remission is not the same as cure — it is the starting point of treatment, not the end. Leukaemia cells can still be present at levels below what standard tests can find; this is why consolidation and maintenance phases continue for years after initial remission. The term oncologists use for this residual disease is Minimal Residual Disease (MRD). Sensitive MRD tests guide how intensively treatment needs to continue. A durable, long-term remission after completing the full course of treatment is what doctors work towards.
Will my child lose their hair? What other side effects should I expect?
Hair thinning or loss is common during treatment, particularly during the more intensive induction and consolidation phases. It is almost always temporary — hair regrows after treatment ends, often with a changed texture or colour at first. Other common side effects include nausea, fatigue, mouth sores, and a higher risk of infection because the medicines lower white cell counts. Weight changes, mood swings, and sleep difficulties are also reported, particularly with steroid courses. The care team will prescribe medicines to prevent or manage these effects and will teach you which symptoms need a same-day call to the oncology team. Most children tolerate treatment better than adults; the paediatric body is remarkably resilient.
Can my child go to school during maintenance treatment?
Many children attend school during the maintenance phase, though this depends on how their blood counts are holding up and whether there are active infections in the school. The maintenance phase medicines are largely given by mouth at home, with regular clinic visits for blood count checks. On days when counts are low, the team may advise keeping your child away from crowds. It is worth informing the school so teachers can alert you if there is a chickenpox or other outbreak. Physical activity, friendships, and routine help children cope with a long treatment course, so the oncology team will actively encourage as normal a life as possible whenever it is medically safe.
What is the role of a spinal tap (lumbar puncture) in ALL treatment?
Leukaemia cells can sometimes travel to the fluid that surrounds the brain and spinal cord (the cerebrospinal fluid, or CSF). A lumbar puncture — a procedure in which a small sample of CSF is drawn from the lower back using a thin needle — allows the team to check whether leukaemia cells have reached the central nervous system (CNS). In childhood ALL, lumbar punctures are performed multiple times during treatment, both to test the CSF and to deliver medicines directly into it as a protective measure. In children, lumbar punctures are done under sedation or general anaesthesia so the procedure is not distressing. CNS involvement does not mean the leukaemia is untreatable; it guides an adjustment to the treatment plan.
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