Acute Lymphocytic Leukemia - Treatment During Remission

Maintenance typically continues until continuous complete remission has lasted 2 to 3 years.

Investigation is ongoing to determine the optimal drugs and schedules to use. For example, the drug thioguanine may be a more effective choice than mercaptopurine. Researchers are also trying to pinpoint patients who would best benefit from aggressive maintenance treatments.

Risk Factors for Relapse after a First Remission

The following are factors that increase the risk for relapse after initial treatments:

Microscopic evidence of leukemia after 20 weeks of therapy (minimal disease)
Age over 30
A high white blood cell count at the time of diagnosis
Disease that has spread beyond the bone marrow to other organs
Certain genetic abnormalities such as the presence of the Philadelphia chromosome or MLL gene translocations
Patients with high disease levels after7 to 14 days of induction therapy
The need for four or more weeks of induction chemotherapy in order to achieve a first complete remission

Patients with one or more of these risk factors may be candidates for bone marrow transplantation once they are in first remission.

Investigative Indicators for Predicting Relapse

A 2001 study suggested that test results showing elevated levels of a peptide called glutathione in blast cells may indicate a higher risk for relapse after treatment.