What is the duration of chemotherapy for 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

Whereas mature B-cell acute lymphoblastic leukemia (ALL) is treated with a 6-month to 8-month course of intensive therapy, achieving acceptable cure rates for patients with B-lineage and T-lineage ALL requires approximately 2-2.5 years of continuation therapy. Attempts to reduce this duration resulted in high relapse rates after therapy was stopped. In the United States, in current B-ALL clinical trials, the total duration of continuation therapy for girls is 2 years from the start of interim maintenance; for boys, it is 3 years from the start of interim maintenance.

The use of continuous dexamethasone in adolescents has been associated with an unacceptably high rate of osteonecrosis of the hips of around 40%, [15] and this medication is therefore omitted from induction and continuation therapy in older children. No data support the hypothesis that a second block of delayed intensification confers any extra benefit.


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