Chemotherapy

Chemotherapy is the main treatment for ALL. The phases of treatment include the following:

Induction Therapy

The first phase of chemotherapy is called “induction therapy.” Induction therapy

Includes a multi-drug regimen based on the patient’s age, subtype and overall health. Drugs used in induction therapy can include
- Vincristine
- Pegaspargase
- Dexamethasone or prednisone
- Daunorubicin or doxorubicin (high-risk groups)
Lasts 4 weeks
Includes staying at the hospital
Has a goal of remission, meaning that leukemia cells are no longer found in bone marrow samples and blood counts are normal

Children with Philadelphia chromosome-positive (Ph+) ALL are also given additional medications.

Over 95 percent of children achieve a remission at the end of induction therapy. However, remission does not mean that your child is cured. Your child still needs more treatment to ensure that the disease does not come back (relapse).

Minimal Residual Disease (MRD). Even when a complete remission is achieved, some leukemia cells that cannot be seen with a microscope may remain in the body. The presence of these cells is referred to as minimal/measurable residual disease (MRD). Patients who have achieved remission after initial treatment but have MRD are at increased risk of disease relapse. Testing for MRD can help your child’s doctor re-evaluate your child’s ALL risk category and determine whether your child may benefit from further intensified therapies.

If your child is in remission but tests positive for MRD, the doctor may prescribe a drug called blinatumomab (Blincyto®). Blinatumomab is approved by the US Food and Drug Administration (FDA) to treat adults and children with:

B-cell ALL and are in first or second complete remission with minimal residual disease (MRD) greater than or equal to 0.1%
Relapsed or refractory B-cell ALL

Central Nervous System (CNS) Prophylaxis. Childhood regimens for ALL typically include treatment to stop the spread of leukemia cells to the central nervous system which includes the brain and spinal cord. CNS-directed therapy is given throughout the entire course of treatment.

Central nervous system-directed therapy may include:

Intrathecal chemotherapy, in which anti-cancer drugs are injected into the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord.
High-dose systemic chemotherapy, in which anti-cancer drugs are injected into a vein and travel through the blood to cells throughout the body.
Radiation therapy to the brain
- Cranial radiation is no longer routinely used in children with ALL, except in those with leukemia cells in their cerebrospinal fluid at the time of diagnosis or those with CNS relapse.

For information about the drugs listed on this page, visit Drug Listings.

Postremission Therapy

“Postremission therapy” refers to treatments given to patients after their disease is in complete remission. Even when MRD test results are negative, undetectable residual cancer cells are believed to remain in the body.

Consolidation Therapy

Consolidation (intensification) therapy begins after induction therapy. Consolidation therapy

Involves higher doses of chemotherapy than those used during the induction phase. Drugs used in the consolidation phase can include:
- High-dose High-dose methotrexate
- Cytarabine
- Vincristine
- 6-mercaptopurine (6-MP)
- Cyclophosphamide
- Pegaspargase
Lasts 4-8 weeks
Does not usually require a hospital stay, but children may be admitted for complications, such as fever and infections
Has the goal of killing any remaining leukemia cells in the body that could cause a relapse

Interim Maintenance

After consolidation therapy, there is a recovery period called “interim maintenance.” Interim Maintenance

Involves chemotherapy that does not cause decreased blood cell counts
Includes methotrexate combined with other chemotherapy agents
May be given in an outpatient clinic or may require a short hospital stay
Has the goal of maintaining remission and allowing bone marrow to recover from effects of therapy

Delayed Intensification

The phase referred to as “delayed intensification”

Involves chemotherapy combinations that may include
- Vincristine
- Dexamethasone
- Pegaspargase
- Doxorubicin
- 6-mercaptopurine
- Cyclophosphamide
- Cytarabine
Lasts about 8 weeks
Usually does not require a hospital stay, but children may be admitted for complications, such as fever and infections
Has the goal of eliminating residual, drug-resistant leukemia cells from the body

Maintenance

The final phase of treatment is called “maintenance.” Maintenance

Regimens include
- Oral 6-mercaptopurine
- Oral methotrexate
- Vincristine and prednisone or dexamethasone
- CNS-directed chemotherapy
Lasts 2-3 years
Includes medications that are taken orally at home and tend to cause less-severe side effects
Has the goal of preventing disease relapse