How is a second relapse or refractory pediatric acute lymphoblastic leukemia (ALL) treated?

Updated: Jan 02, 2019
  • Author: Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP; Chief Editor: Jennifer Reikes Willert, MD  more...
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Despite successful reinduction and consolidation, many patients with ALL eventually relapse a second time. With regard to second and subsequent relapse, no standard treatment regimen has been established; oncologists must choose among various combinations of drugs. Long-term survival for all patients with ALL after a second relapse remains poor, in the range of 10-20% and some families may opt for palliative care.

The FDA approved the first CAR T-cell therapy in August 2017. Tisagenlecleucel is a CD19-directed genetically modified autologous T-cell immunotherapy indicated for patients aged 25 years or younger with B-cell precursor ALL that is refractory or in second or later relapse. [29]

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