Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Postinduction Treatment for Specific ALL Subgroups
Treatment options for infants withoutMLLtranslocations
The optimal treatment for infants without MLL translocations also remains unclear.
- On the Interfant-99 trial, patients without MLL translocations achieved a relatively favorable outcome with the cytarabine-intensive treatment regimen (4-year EFS was 74%).
- A favorable outcome for this subset of patients was obtained in a Japanese study using therapy comparable to that used to treat older children with ALL; however, that study was limited by small numbers.
Treatment options under clinical evaluation for infants with ALL
Treatment options under clinical evaluation include the following:
- Interfant-06 Study Group trial (DCOG-INTERFANT-06) (Different Therapies in Treating Infants With Newly Diagnosed Acute Leukemia): The Interfant-06 Study Group is conducting an international collaborative randomized trial (including sites in the United States) to test whether an ALL/acute myeloid leukemia hybrid regimen might improve outcomes for infants with MLL-rearranged ALL. The role of allogeneic transplantation in first remission is also being assessed in high-risk patients (defined as infants with MLL-rearranged ALL, younger than 6 months, and WBC >300,000 /µL) or poor peripheral blood response to steroid prophase. Infants with MLL-rearranged ALL with high MRD at end of consolidation phase are also eligible for allogeneic SCT in first remission regardless of other presenting features.
- COG-AALL0631(Combination Chemotherapy With or Without Lestaurtinib in Treating Infants With Newly Diagnosed ALL): In this COG study of infant ALL, an FLT3 inhibitor, lestaurtinib, is being studied in infants with MLL rearrangement. Infants with MLL rearrangement are known to have a high level of FLT3 mRNA expression and lestaurtinib has been shown to selectively kill MLL-rearranged ALL cells in vitro and in vivo. This study combines lestaurtinib with intensive chemotherapy previously utilized in POG-P9407. There is an initial safety/activity phase followed by an efficacy phase in which children will be randomly assigned to chemotherapy with or without lestaurtinib. Infants with germline MLL will be nonrandomly assigned to less-intensive chemotherapy without lestaurtinib.
Adolescent and Young Adult Patients With ALL
Older children and adolescents (aged 10 years and older) with ALL more frequently present with adverse prognostic factors at diagnosis, including T-cell immunophenotype and Philadelphia chromosome–positivity (Ph+), and have a lower incidence of favorable cytogenetic abnormalities.[26,27] These patients have a less favorable outcome than children aged 1 to younger than 10 years at diagnosis, and more aggressive treatments are generally employed.
Studies from the United States and France were among the first to identify the difference in outcome based on treatment regimens. Other studies have confirmed that older adolescent and young adult patients fare better on pediatric rather than adult regimens.[27,29,30,31,32]; [Level of evidence: 2A] These study results are summarized in Table 3.