Overview of treatment options for acute lymphocytic leukemia – pro

Children with acute lymphocytic leukemia (ALL) who undergo treatment have about an 80 percent cure rate. Newer treatments may soon boost the child cure rate to as high as 90 percent. Adults have around a 40 percent cure rate. Individuals who fall in the adolescent group can be elgitimately treated with children’s protocols or as adults.

Induction therapy. The purpose of the first phase of treatment is to kill most of the leukemia cells in the blood and bone marrow.
Consolidation therapy. Also called post-remission therapy, this phase of treatment is aimed at destroying the leukemia cells remaining in the brain or spinal cord. Extra spinal taps and radiation therapy are considered crucial during this phase to decrease the risk of relapse.
Maintenance therapy. The third phase of treatment prevents leukemia cells from regrowing. The treatments used in this stage are often given at much lower doses.

Children with acute lymphocytic leukemia typically receive treatment to kill leukemia cells hiding in the central nervous system during each phase of therapy. This is called central nervous system sanctuary therapy, central nervous system preventive therapy or intrathecal chemotherapy. In this type of chemotherapy, anti-cancer drugs are injected directly into the fluid that covers the spinal cord. The drugs used here are methotrexate and Ara-C.

The three phases of treatment typically take two and a half to three and a half years. Chemotherapy is the major form of remission induction therapy for children and adults with acute lymphocytic leukemia. It usually lasts about four weeks, sometimes longer.

Children with standard-risk ALL usually receive three drugs for the first month of treatment — vincristine, L-asparaginase, and a corticosteroid such as prednisone or dexamethasone. Children in the high-risk group may also receive an anthracycline drug such as daunorubicin. Adults with ALL receive a similar combination that usually includes vincristine, a corticosteroid and an anthracycline drug.

Some of these same medications are also used in the consolidation and maintenance phases. However, the later phases usually rely on less intensive regimens that don’t require staying in the hospital.

Gleevec and stem cell transplantation is not reviewed in this brief post.

Samuel ED, Sakamoto KM.. Topics in pediatric leukemia–acute lymphoblastic leukemia. MedGenMed. 2005 Mar 7;7(1):23

Redaelli A. A systematic literature review of the clinical and epidemiological burden of acute lymphoblastic leukaemia (ALL). Eur J Cancer Care. 2005;14(1):53-62.

Rowe JM. Induction therapy for adults with acute lymphoblastic leukemia (ALL): results of over 1,500 patients from the international ALL Trial: MRC UKALL XII / ECOG E2993. Blood. 2005;Aug 16

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