Childhood Acute Lymphoblastic Leukemia Treatment–Health Professional Version (PDQ®)

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Changes to this Summary (03/30/2016)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Childhood Acute Lymphoblastic Leukemia (ALL)

Added text to state that germline ETV6 variations have been associated with predisposition to childhood ALL (cited Moriyama et al. as reference 36).

Risk-Based Treatment Assignment

The Weight at diagnosis and during treatment subsection was renamed from Obesity at diagnosis.

Added text to state that in a study of 762 pediatric patients with ALL, the Dutch Childhood Oncology Group found that those who were underweight at diagnosis had an almost twofold higher risk of relapse compared with non-underweight patients, although this did not result in a difference in event-free survival or overall survival (OS). Patients with loss of body mass index during the first 32 weeks of treatment had similar rates of relapse as other patients, but had significantly worse OS, primarily because of poorer salvage rates after relapse (cited den Hoed et al. as reference 81).

Added text to state that whole-genome sequencing has determined that cases of infant ALL with MLL gene rearrangements have few additional genomic alterations, none of which have clear clinical significance (cited Andersson et al. as reference 168).

Revised text to state that the t(1;19) translocation may occur as either a balanced translocation or as an unbalanced translocation and is the primary recurring genomic alteration of the pre-B ALL immunophenotype (cited Fischer et al. as reference 171).

Added text about the TCF3-HLF gene fusion (cited Minson et al. as reference 176).

Revised text to state that genomic alterations in CRLF2, a cytokine receptor gene located on the pseudoautosomal regions of the sex chromosomes, have been identified in 5% to 10% of cases of B-precursor ALL and they represent approximately 50% of cases of Philadelphia chromosome–like ALL .

Treatment for Newly Diagnosed Childhood ALL

Added Place et al. as reference 21.

Added text about the results of a randomized comparison of intravenous (IV) PEG-L-asparaginase versus intramuscular native E. coli asparaginase (added level of evidence 1iiC).

Added text to state that a trial of IV Erwinia L-asparaginase given on Monday-Wednesday-Friday schedule to patients with an allergy to PEG-L-asparaginase demonstrated therapeutic serum asparaginase enzyme activity in 83% of patients 48 hours after a dose but in only 43% of patients 72 hours after a dose. If IV Erwinia is given on a Monday-Wednesday-Friday schedule, the authors suggest that 72-hour nadir enzyme activity levels be monitored to ensure therapeutic levels (cited Vrooman et al. as reference 28).

Postinduction Treatment for Childhood ALL

Added text to state that the frequency of grade 3 and 4 toxicities that occurred during therapy on the POG-9404 trial was similar between the randomized groups, and there was no difference in cumulative incidence of second malignant neoplasms. Three years after initial diagnosis, left ventricular shortening fraction and left ventricular wall thickness were both significantly worse in patients who received doxorubicin alone than in patients who received dexrazoxane, indicating that dexrazoxane was cardioprotective (cited Asselin et al. as reference 33).

CNS-Directed Therapy for Childhood ALL

Added text about a meta-analysis of aggregated data from more than 16,000 patients treated between 1996 and 2007 by ten cooperative groups that showed that the use of cranial radiation therapy did not appear to impact 5-year overall survival or cumulative incidence of any event (cited Vora et al. as reference 25).

Treatment of Relapsed Childhood ALL

Revised text to state that in some studies, patients with combined marrow/extramedullary relapse had a better prognosis than did those with a marrow relapse; however, other studies have not confirmed this finding (cited Masurekar et al. as reference 16).

Added hematopoietic stem cell transplantation as a standard treatment option for childhood ALL that has recurred in the central nervous system.

This summary is written and maintained by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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