Study Helps Define Treatment Options in Children With Hard-to-Treat Leukemias

For some children with acute lymphocytic leukemia (ALL) who don’t improve after initial induction chemotherapy, getting more chemotherapy may be a better option than having a stem cell transplant, according to an international study.

ALL (also known as acute lymphoblastic leukemia) is a kind of cancer of the blood and bone marrow. It is the most common type of leukemia in children and teens. Initial treatment is induction chemotherapy, an intensive combination of drugs typically given for about a month after a child is diagnosed. Induction chemotherapy is able to bring about a remission in more than 95% of patients, and most of these children will go on to be cured.

However, a very small portion of children – about 2% to 3%, according to the researchers – still have signs of leukemia in their blood or bone marrow after induction. Long-term survival for these children is only about 32% overall, according to the researchers. The researchers looked back at more than a thousand of these children for their study.

Because these children are considered to be at high risk, after induction chemotherapy they are often given high-dose chemotherapy followed by a stem cell transplant (also known as a bone marrow transplant) in hopes of increasing the chances of cure. But this intensive treatment also raises the risks of both short- and long-term side effects.

The new study showed that some of these children may not need such intensive treatment.

The researchers found that some children with more favorable leukemias had better outcomes, even when just getting more chemotherapy without a stem cell transplant. For example, younger children with a type known as precursor B-cell ALL and without any poor prognostic features had a 10-year survival rate of about 72%. They actually did better if they got just more chemotherapy instead of a stem cell transplant.

For other children, such as those who were older, those with T-cell leukemias, or those with leukemias that had certain gene changes, the outlook was not as good overall. These children were more likely to benefit from a stem cell transplant.

In a statement, researcher Ching-Hon Pui, MD, chair of St. Jude’s Children’s Research Hospital Department of Oncology said, “These results tell us that induction failure should no longer be considered an automatic indication for a [stem cell] transplant.”

The study was published in the New England Journal of Medicine.

The American Cancer Society medical and editorial content team
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Outcomes after Induction Failure in Childhood Acute Lymphoblastic Leukemia. Published in the April 12, 2012 issue of the New England Journal of Medicine (Vol. 366, No. 15). First author: Martin Schrappe, MD, University Medical Center Schleswig-Holstein, Kiel, Germany.


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