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Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment for Newly Diagnosed Childhood ALL

Standard Treatment Options for Newly Diagnosed ALL

Standard treatment options for newly diagnosed childhood acute lymphoblastic leukemia (ALL) include the following:

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  1. Chemotherapy.

Remission induction chemotherapy

The goal of the first phase of therapy (remission induction) is to induce a complete remission (CR). This phase typically lasts 4 weeks. Overall, approximately 98% of patients with newly diagnosed B-precursor ALL achieve CR by the end of this phase, with somewhat lower rates in patients with T-cell ALL or high presenting leukocyte counts.[1,2,3,4,5]

Induction chemotherapy consists of the following drugs, with or without an anthracycline:

  • Vincristine.
  • Corticosteroid (prednisone or dexamethasone).
  • L-asparaginase.

The Children's Oncology Group (COG) protocols do not administer anthracycline during induction to patients with National Cancer Institute standard-risk precursor B-cell ALL.

Patients treated by the following study groups receive an induction regimen with four or more drugs regardless of presenting features:

  • Berlin-Frankfurt-Münster Group in Europe.[1]
  • St. Jude Children's Research Hospital.[2]
  • Dana-Farber Cancer Institute ALL Consortium.[3]

The most common four-drug induction regimen is vincristine, corticosteroid (either dexamethasone or prednisone), L-asparaginase, and either doxorubicin or daunorubicin.[6] Some studies have suggested that this more intensive induction regimen may result in improved event-free survival (EFS) in patients presenting with high-risk features, but it may not be necessary for favorable outcome provided that adequate postremission intensification therapy is administered.[7,8] The COG reserves the use of a four-drug induction for patients with high-risk B-precursor ALL and T-cell ALL.

Corticosteroid therapy

Many current regimens utilize dexamethasone instead of prednisone during remission induction and later phases of therapy.

Evidence (dexamethasone):

  1. The Children's Cancer Group conducted a randomized trial that compared dexamethasone and prednisone in standard-risk ALL patients.
    • The trial reported that dexamethasone was associated with a superior EFS.[9]
  2. Another randomized trial was conducted by the United Kingdom Medical Research Council.[10]
    • The trial demonstrated that dexamethasone was associated with a more favorable outcome than prednisolone in all patient subgroups.
    • Patients who received dexamethasone had a significantly lower incidence of both central nervous system (CNS) and non-CNS relapses than patients who received prednisolone.[10]
  3. Other randomized trials did not confirm an EFS advantage with dexamethasone.[11,12]
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