What is the role of maintenance therapy in the treatment of 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

Maintenance (or continuation therapy) is the last and longest phase of treatment. This consists of intrathecal MTX at least every 3 months, vincristine and steroid pulses every 1-3 months, daily 6-MP, and weekly MTX. The doses of last 2 agents are adjusted based on peripheral neutrophil counts, in order to optimize therapy. Although vincristine and steroid pulses improve outcomes, they can be associated with avascular necrosis of the bone and vincristine neuropathy, and the current COG standard risk ALL trial is evaluating whether these 2 agents can be given every 3 months.


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