Hematologic Malignancies Program

Patient and Family Education

Childhood Acute Lymphocytic Leukemia

Phases of Treatment

There is no staging for childhood acute lymphocytic leukemia. The disease is generally considered either untreated, in remission, or recurrent/refractory. The choice of treatment is based on the child's age, the results of laboratory tests, and whether or not the child has ever been treated for leukemia.

Untreated childhood acute lymphocytic leukemia

Untreated childhood acute lymphocytic leukemia means that no treatment has been given except to treat symptoms. There are too many white blood cells in the blood and bone marrow, and there may be other signs and symptoms of leukemia. The child's treatment will probably be remission induction chemotherapy to kill cancer cells and cause the leukemia to go into remission. Induction chemotherapy is usually successful in inducing remission. Intrathecal and/or high-dose systemic chemotherapy, with or without radiation therapy to the brain, may also be given to prevent the spread of cancer cells to the brain and spinal cord. Clinical trials are testing new ways of inducing remission.

Acute lymphocytic leukemia in remission

Remission means that treatment has been given and that the numbers of white blood cells and other blood cells in the blood and bone marrow are normal. There are no signs or symptoms of leukemia. The child's treatment will probably be intensive chemotherapy to kill any remaining cancer cells. Intrathecal and/or high doses of systemic chemotherapy, with or without radiation therapy to the brain, may also be given during this phase of treatment to prevent the spread of cancer cells to the brain and spinal cord. Following intensification therapy, chemotherapy generally continues until the child has been in continuous remission for several years.

Recurrent/refractory acute lymphocytic leukemia

Recurrent disease means that the leukemia has come back (recurred) after going into remission. Refractory disease means that the leukemia has failed to go into remission following treatment. Treatment depends on the type of treatment the child received before, how soon the cancer came back following treatment, and whether leukemia cells are found outside the bone marrow. The child's treatment will probably be systemic or intrathecal chemotherapy, radiation therapy, or bone marrow transplantation. Parents may want to consider entering their child into a clinical trial of new chemotherapy drugs or bone marrow transplantation.

Phases

There are generally four phases of treatment for childhood acute lymphocytic leukemia, each of which has a specific purpose. The first phase is called remission induction therapy. The purpose of remission induction therapy is to kill as many of the leukemia cells as possible and make patients go into remission.

The second phase, called central nervous system (CNS) prophylaxis, is preventive therapy using intrathecal and/or high-dose systemic chemotherapy to the CNS to kill any leukemia cells present there. It is also intended to prevent the spread of cancer cells to the brain and spinal cord, even if no cancer has been detected. Radiation therapy to the brain may also be given in addition to chemotherapy for this purpose. CNS prophylaxis is often given in conjunction with consolidation/intensification therapy (see below).

Once a child goes into remission and there are no signs of leukemia, a third phase of treatment called consolidation or intensification therapy is given. Consolidation therapy uses high-dose chemotherapy to attempt to kill any remaining leukemia cells.

The fourth phase of treatment, called maintenance therapy, uses chemotherapy for several years to maintain the remission.

This page was last updated on: October 7, 2009.