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

SECTIONS

Changes to this Summary (05/20/2016)

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.

Risk-Based Treatment Assignment

Added text to state that patients with homozygosity for TPMT variants associated with low activity typically are treated with reduced doses of 6-mercaptopurine to avoid excessive toxicity.

Added text to state that gene polymorphisms may also affect the expression of proteins that play central roles in the cellular effects of anticancer drugs; for example, patients who are homozygous for a polymorphism in the promoter region of CEP72 are at increased risk of vincristine neurotoxicity (cited Diouf et al., as reference 94).

Treatment for Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (ALL)

Added text about the AIEOP-BFM 2000 trial that randomly assigned 3,720 patients to receive either dexamethasone or prednisone during multiagent remission induction following a 7-day prednisone prophase. Dexamethasone was associated with higher incidence of life-threatening events, resulting in a significantly higher induction death rate; however, the 5-year cumulative incidence of relapse was significantly lower with dexamethasone, resulting in superior 5-year event-free survival. No difference in overall survival was observed (cited Moricke et al as reference 11).

Postinduction Treatment for Childhood ALL

Revised text to state that patients aged 1 to 30 years with very high-risk features are eligible to be treated on the very high-risk stratum of COG-AALL1131.

Postinduction Treatment for Specific ALL Subgroups

Added text about COG-AALL1131, a trial treating patients classified as high risk who lack very high-risk features and two groups of NCI standard-risk patients who otherwise lack very high-risk features: (1) those without favorable genetics (no ETV6-RUNX1 or double trisomies 4 and 10) and with day 8 peripheral blood minimal residual disease (MRD) greater than 1%; and (2) those with favorable cytogenetics and high marrow MRD at day 29. Very high-risk patients are treated with a BFM backbone including high-dose methotrexate during the first interim maintenance phase, a single delayed intensification phase, and a second interim maintenance phase with Capizzi methotrexate plus PEG-asparaginase.

Treatment of Relapsed Childhood ALL

Revised text to state that age older than 6 years at diagnosis was noted in one study as an adverse prognostic factor for patients with an isolated extramedullary relapse, while a second study suggested age 10 years as a better cutoff.

Added text to state that although some reports have suggested a possible role for hematopoietic stem cell transplantation (HSCT) for patients with isolated central nervous system disease with very early relapse and T-cell disease, there is less evidence for the need for HSCT in early relapse and no evidence in late relapse.

Added text to state that the 8-year probabilities of leukemia-free survival adjusted for age (58%) and duration of first remission (66%) were similar.

Added text about the MRC ALLR3 trial, which tested intensive induction with mitoxantrone versus idarubicin in relapsed ALL patients, defining a superior outcome when mitoxantrone was used.

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.

< Previous section
Treatment of Relapsed Childhood ALL

Next section >
About This PDQ Summary