Acute Lymphocytic Leukemia - Treatment to Achieve Remission

Highlights	Complications	Treatment to Achieve Remission
Introduction	Diagnosis	Treatment During Remission
Symptoms	Prognosis	Treatment After Relapse
Causes	Treatment	Resources
Risk Factors	Home Management	References

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Treatment to Achieve Remission

The aim of induction therapy, the first phase, is to reduce the number of leukemia cells to undetectable levels. The general guidelines for induction therapy are as follows:

Patients are given intensive chemotherapy that uses powerful multi-drug regimens. (Infants require special regimens not discussed here.)
For both children and adults, some of these therapies are administered orally, others intravenously.
Hospitalization is usually necessary at some point to help prevent infection and to administer blood products. However, much of this therapy can be given on an outpatient basis.
After the first cycle of induction, bone marrow tests are done to determine if the patient is in remission.
Another bone marrow test is sometimes done about a week later to confirm the first results.
A bone marrow transplant is considered for patients who do not respond at all to induction treatment.

Drugs Used for Induction Chemotherapy

Drugs Used for Standard or Low-Risk Patients. A three-drug regimen is typically used for standard or low-risk patients. (A fourth drug, such as cyclophosphamide, may be added for adult patients.) Examples of drugs used in regimens for children include:

Vincristine
Corticosteroids (prednisone or dexamethasone) --a 2003 study reported better survival rates with dexamethasone compared to prednisone.
Asparaginase -- several forms are available. Investigation on a potent form called E-coli asparaginase (Asparaginase medac) is promising for preventing relapse, particularly second relapses, but this drug is very toxic and increases the risk for blood clots.

When this regimen is used together with CNS prophylaxis, remission rates of greater than 95% have been achieved in children. In a 2001 study, researchers reported that the most effective regimen for many childrenuses dexamethasone after the first month with a longer duration for asparaginase (30 rather than the standard 20 weeks).

Drugs Used for High-Risk Children. A four or five-drug regimen is used for many high-risk children. An example of a four-drug regimen would be vincristine, prednisone/dexamethasone, plus asparaginase, and an anthracycline (such as doxorubicin, daunorubicin, or epirubicin).

Drugs Used for Specific High-Risk Adults. Adult patients have a poorer outlook than children do, and investigators and looking for more effective chemotherapy regimens. For example, cyclophosphamide-based regimens are used in adult patients with certain types of ALL. In a 2005 study, patients treated with an investigational regimen of cytabarine and high-dose mitoxantrone experienced a much higher rate of remission and survival than patients treated with the standard L-20 chemotherapy regimen of vincristine, prednisone, cyclophosphamide, and doxorubicin. Patients with the Philadelphia chromosome also benefited from the investigational treatment.