What are the phases of treatment for pediatric acute lymphoblastic leukemia (ALL)?

Updated: Jan 03, 2019
  • Author: Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP; Chief Editor: Jennifer Reikes Willert, MD  more...
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Answer

Leukemia is a systemic disease, and treatment is primarily based on chemotherapy. However, the different forms of ALL require different approaches for optimal results. Treatment of subclinical CNS leukemia is an essential component of ALL therapy.

Treatment for ALL typically consists of the following phases:

  • Remission-induction phase (eg, dexamethasone or prednisone, vincristine, asparaginase, daunorubicin)

  • Intensification/consolidation phase: The importance of this phase is undisputed, but consensus is scarce on the best regimens and duration of treatment. Current Children's Oncology Group (COG) ALL protocols use a therapeutic backbone that was originally introduced in Berlin-Frankfurt-Muenster (BFM) clinical trials in the 1980s. This includes administration of cytarabine, cyclophosphamide, dexamethasone, asparaginase, doxorubicin, MTX, 6-MP, 6-thiouguanine, and vincristine.

  • CNS-directed therapy consists of systemic chemotherapy that enters the CSF, as well as intrathecal chemotherapy administered throughout the entire course of treatment, which is primarily MTX but sometimes includes hydrocortisone and cytarabine (“triple-intrathecal therapy”).

  • Continuation therapy targeted at eliminating residual disease (eg, MTX, 6-MP, vincristine and glucocorticoid pulses)


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