- How is childhood leukemia treated?
- Immediate treatment of childhood leukemia
- Surgery for childhood leukemia
- Radiation treatment for childhood leukemia
- Chemotherapy for childhood leukemia
- Targeted therapy for childhood leukemia
- High-dose chemotherapy and stem cell transplant for childhood leukemia
- Treatment of children with acute lymphocytic leukemia (ALL)
- Treatment of children with acute myeloid leukemia (AML)
- Treatment of children with acute promyelocytic leukemia (APL)
- Treatment of children with juvenile myelomonocytic leukemia (JMML)
- Treatment of children with chronic myelogenous leukemia (CML)
Treatment of children with acute lymphocytic leukemia (ALL)
The main treatment for children with acute lymphocytic (lymphoblastic) leukemia (ALL) is chemotherapy (chemo), which has 3 phases:
- Consolidation (also called intensification)
Children with ALL are treated by risk group status to make sure that the correct types and doses of chemo drugs are given.
The goal of induction is to bring about a remission. This means that leukemia cells are no longer found in bone marrow samples, the normal marrow cells return, and the blood counts become normal. (A remission is not the same as a cure.) More than 95% of children with ALL will go into remission after 1 month of treatment.
Treatment during this month is intense, and your child may spend some or much of this time in the hospital. Frequent doctor visits might also be needed.
All children will need to have spinal taps to put chemo right into the cerebrospinal fluid (CSF) to try to keep cancer from spreading to the brain and spinal cord. Some children may need radiation to the head, too, but doctors try to avoid this if they can because it may cause some problems in thinking and growth, no matter how low the dose.
The goal of this phase (also called intensification) is to get rid of leukemia cells in hidden places. This phase lasts about 1 to 2 months. Several chemo drugs are used, depending on the child’s risk category. Some children may benefit from a stem cell transplant at this time.
If the leukemia stays in remission after the first 2 phases of treatment, this last phase can begin. The total length of therapy for all 3 phases is 2 to 3 years for most children with ALL. Because boys are at higher risk for relapse than girls, many doctors favor giving them several more months of treatment.
Treatment of residual disease
Treatment plans may change if the leukemia doesn’t go away in the first few months. Soon after treatment has begun the doctor will check the child’s bone marrow to see if the leukemia is going away. If not, treatment may be increased or given for a longer time. When the leukemia seems to have gone away, the doctor may do special blood tests to look for leukemia cells. If any are found, then once again, chemo may be increased or prolonged.
Treatment of recurrent ALL
If the leukemia comes back during or after treatment, the child will again be treated with chemo. This may include the same or different drugs, depending on how long the remission lasted. A stem cell transplant may be considered for children whose leukemia comes back soon after starting treatment, especially if there is a brother or sister who is a good match. Stem cell transplant may also be used for other children who relapse after a second course of chemo.
Some children have a relapse in which leukemia cells are found in one part of the body (such as the CSF or the testicles) but are not found in the bone marrow. These children may have intense chemo, sometimes along with radiation or surgery to the affected area.
If ALL doesn’t go away completely or if it comes back after a stem cell transplant, it can be very hard to treat. For some children, newer types of immunotherapy (treatments that boost the body’s immune response against the leukemia) might be helpful.
Last Medical Review: 05/13/2015
Last Revised: 02/03/2016