Childhood Acute Lymphoblastic Leukemia : Treatment

by National Cancer Institute

(Page 3 of 3)

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column (intrathecal), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type of the cancer being treated.

Intrathecal chemotherapy may be used to treat childhood ALL that has spread, or may spread, to the brain and spinal cord. When used to prevent cancer from spreading to the brain and spinal cord, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis. Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. External radiation therapy may be used to treat childhood ALL that has spread, or may spread, to the brain and spinal cord. When used this way, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis.

Chemotherapy with stem cell transplant

Stem cell transplant is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. A stem cell transplant using stem cells from a donor who is not related to the patient is being studied in clinical trials.

New types of treatment are being tested in clinical trials. These include the following:

High-dose chemotherapy

High-dose chemotherapy is giving high doses of anticancer drugs to kill cancer cells. This treatment often causes the bone marrow to stop making blood cells and can cause other serious side effects. High-dose chemotherapy is usually followed by stem cell transplant to restore the bone marrow. Clinical trials are studying high-dose chemotherapy for certain patients, including children whose ALL does not go into remission after induction therapy.

Other drug therapy

Imatinib mesylate (Gleevec) is a type of anticancer drug called a tyrosine kinase inhibitor. It blocks the enzyme, tyrosine kinase, that causes stem cells to develop into more white blood cells (granulocytes or blasts) than the body needs.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Treatment Options for Childhood Acute Lymphoblastic Leukemia

Untreated Childhood Acute Lymphoblastic Leukemia

Standard treatment of childhood acute lymphoblastic leukemia (ALL) during the induction phase is usually combination chemotherapy with intrathecal chemotherapy. Radiation therapy to brain may also be given.

Standard treatment of childhood ALL during the consolidation/intensification phase is usually combination chemotherapy with intrathecal chemotherapy. Radiation therapy to brain may also be given.

Standard treatment of childhood ALL during the maintenance phase is usually combination chemotherapy with intrathecal chemotherapy. Radiation therapy to brain may also be given.

Some of the treatments being studied in clinical trials for childhood ALL include the following:

• Combination chemotherapy with or without intrathecal chemotherapy. Radiation therapy to brain may also be given.
• Combination chemotherapy followed by stem cell transplant using stem cells donated by a brother or sister.

Information about these and other clinical trials is available from the NCI Web site.

Childhood Acute Lymphoblastic Leukemia Subgroups

Standard treatment of T-cell childhood acute lymphoblastic leukemia (ALL) is usually combination chemotherapy with intrathecal chemotherapy and may include radiation therapy to the brain. One of the treatments being studied in clinical trials for T-cell childhood ALL is a new kind of anticancer drug.

Treatment of infants with ALL is usually a clinical trial of systemic chemotherapy with intrathecal chemotherapy.

Standard treatment of Philadelphia chromosome-positive childhood ALL is usually a stem cell transplant using stem cells donated by a brother or sister. One of the treatments being studied in clinical trials for Philadelphia chromosome-positive childhood ALL is imatinib mesylate (Gleevec).

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Recurrent Childhood Acute Lymphoblastic Leukemia

Standard treatment of recurrent childhood ALL may include the following:

• Combination chemotherapy.
• Systemic chemotherapy and intrathecal chemotherapy with or without radiation therapy to the brain and spinal cord.
• Chemotherapy with stem cell transplant, using stem cells from a donor who is related to the patient, with or without total-body irradiation.
• Chemotherapy plus radiation therapy for cancer that recurs in the testicles only.

Some of the treatments being studied in clinical trials for recurrent childhood ALL include the following: A clinical trial of chemotherapy with stem cell transplant, using stem cells from a donor who is not related to the patient, with or without total-body irradiation. A clinical trial of new anticancer drugs and new combination chemotherapy treatments.

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