Which chemotherapy agents are used to treat relapsed 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

Most standard regimens use a 4-drug induction backbone, with glucocorticoid, vincristine, an anthracycline (such as daunorubicin or doxorubicin) and asparaginase; this was shown as early as the 1980s to achieve second remission in more than 90% of relapsed ALL patients in a Pediatric Oncology Group Study (POG 8303). COG AALL01P2 used this 4-drug treatment regimen, and gave additional blocks of intensive chemotherapy with cyclophosphamide/etoposide and/or high dose cytarabine. Using this regimen, of the 63 patients in early relapse, 68% achieved CR2, and of 54 patients in late relapse, 96% achieved CR2.

The UK ALL R3 regimen studied 212 patients with relapsed ALL and compared the anthracycline drug mitoxantrone to idarubicin in a four-drug induction regimen, and obtained a long-term progression-free survival rate of 64% at 3 years in 103 patients with relapsed ALL on the mitoxantrone arm. [27]


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