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

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Changes to This Summary (08/17/2018)

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 Athale et al. as reference 61.

Added text to state that a large retrospective study from the international Berlin-Frankfurt-Münster (BFM) group demonstrated that initial therapy with an acute lymphoblastic leukemia (ALL)-type regimen was associated with a superior outcome compared with acute myeloid leukemia (AML)-type or combined ALL/AML regimens, particularly in cases with CD19 positivity or other lymphoid antigen expression. In this study, hematopoietic stem cell transplanation (HSCT) in first complete remission was not beneficial, with the possible exception of cases with morphologic evidence of persistent marrow disease after the first month of treatment (cited Hrusak et al. as reference 119).

Added text to state that the Associazione Italiana di Ematologia e Oncologia Pediatrica (AIEOP)-BFM group reported that IKZF1 deletions were significant adverse prognostic factors only in B-cell ALL patients with high end-induction minimal residual disease (MRD) and in whom co-occurrence of deletions of CDKN2A, CDKN2B, PAX5, or PAR1 were identified (cited Stanulla et al. as reference 216).

The T-cell ALL cytogenetics/genomics subsection was extensively revised.

Postinduction Treatment for Specific ALL Subgroups

Added Mogensen et al. as reference 50.

Added text about the results of the COG-AALL0622 study that tested the use of dasatinib combined with a chemotherapy backbone similar to that used in the COG-AALL0031 study (cited Slayton et al. as reference 73 and level of evidence 2A).

Treatment of Relapsed Childhood ALL

Added text about the results of a global phase II trial of the anti-CD19 4-1BB vector that led to U.S. Food and Drug Administration approval of tisagenlecleucel for children with multiply relapsed or refractory B-cell ALL (cited Maude et al. as reference 138).

Added text to state that standard approaches for treating isolated testicular relapse in North America include local radiation therapy along with intensive chemotherapy.

Added text to state that there are limited clinical data concerning outcome without the use of radiation therapy or orchiectomy. Treatment protocols that have tested this approach have incorporated intensified dosing of chemotherapy agents that may be able to achieve antileukemic levels in the testes.

Added text about the results of the COG AALL02P2 trial that tested whether radiation therapy could be eliminated for patients with late isolated testicular relapse (cited Barredo et al. as reference 153).

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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