Treatment of acute lymphoblastic leukaemia

Treatment of ALL consists of the following:

• remission induction phase
• intensification (or consolidation) phase
• continuation therapy to eliminate residual disease (1)

The only exception to this is in patients with mature B cell ALL where short term intensive chemotherapy (including high-dose methotrexate, cytarabine, and cyclophosphamide are used) (1).

Therapy directed at CNS is started early in the clinical course which is aimed at preventing relapses attributable to leukemic cells sequestered in this site (1).

Children respond well to treatment:

• 95% achieve complete remission
• 50-60% of whom are cured with postremission chemotherapy

Fewer advances have been achieved in adults:

• 80% achieve complete remission
• about 35% achieve long-term disease-free survival

Notes:

• allogenic transplantation has shown clear benefits in the following patients who are at high risk of ALL:
  • individuals with Philadelphia chromosome-positive disease
  • poor initial response to treatment (1)
  • it is also useful in improving the outcome of adults with the t(4;11) subtype of ALL (but the benefits in infants with this genotype is controversial) (1).

Reference:

• 1. Pui CH, Robison LL, Look AT. Acute lymphoblastic leukaemia. Lancet. 2008;371(9617):1030-43.