Treatment of children with acute lymphocytic leukemia

The main treatment for children with acute lymphocytic leukemia (ALL) is chemotherapy (chemo), which has 3 phases:

• Induction
• Consolidation (also called intensification)
• Maintenance

Children with ALL are divided into risk groups to make sure that the correct types and doses of chemo drugs are given.

Induction

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.

During induction, frequent trips to the doctor will be needed. Your child may spend some or much of this time in the hospital. Children with standard-risk ALL often receive 3 drugs for the first month of treatment. A fourth drug is typically added for high-risk children.

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 central nervous system (brain and spinal cord). And some, such as those with T-cell leukemia or cancer cells in the CSF, may need radiation to the head, too. This was more common in the past, but recent studies have found that many children even with high-risk ALL may not need radiation therapy if they are given more intense chemo. Doctors try to avoid radiation because, no matter how low the dose, it may cause some problems in thinking and growth.

Consolidation

The goal of this phase (also called intensification) is to get rid of leukemia cells from places where they can "hide." This phase lasts about 1 to 2 months. Several drugs are used, depending on the child's risk category. Some children may benefit from a stem cell transplant at this time.

Maintenance

If the leukemia stays in remission after the first 2 phases of treatment, this last phase, maintenance chemo, 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

All these treatment plans may change if the leukemia doesn't completely go away in the first few months. Soon after treatment has begun the doctor may 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 disappeared, the doctor may do a special chemical test 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 within 6 months of 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 cerebrospinal fluid or the testicles) but are not found in the bone marrow. These children may have intense chemo, sometimes along with radiation treatment to the affected area.