Standard Phases and Treatments
Children with ALL should have their treatment planned by a team of doctors with expertise in treating childhood leukemia.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with leukemia and who specialize in certain areas of medicine. These may include specialists such as pediatricians, hematologist, medical oncologists, social workers, and psychologists.
Regular follow-up exams are very important. Treatment can cause side effects long after it has ended. These are called late effects. Late effects of treatment for ALL also include the risk of second cancers (new types of cancer), especially brain tumors. Radiation therapy to the brain may cause changes in mood, feelings, thinking, learning, or memory. Children younger than 4 years have a higher risk of side effects from radiation therapy to the brain.
The treatment of childhood ALL usually has three phases.
- Remission Induction: The goal is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.
- Consolidation/Intensification: This begins once the leukemia is in remission. The goal of consolidation/intensification therapy is to kill any leukemia cells that remain in the body and may cause a relapse.
- Maintenance: The goal is to kill any remaining leukemia cells that may regrow and cause a relapse. Often the cancer treatments are given in lower doses than those used during the remission induction and consolidation/intensification phases. Not taking medication as ordered by the doctor during maintenance therapy increases the chance the cancer will come back. This is also called the continuation therapy phase.
Four types of standard treatment are used:
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Children with high-risk ALL receive more anticancer drugs and higher doses of anticancer drugs than children with standard-risk ALL.
Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
Stem cell transplant is a method of giving high doses of chemotherapy and sometimes total-body irradiation, and then replacing the blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of a donor. After the patient receives treatment, the donor’s stem cells are given to the patient through an infusion. These reinfused stem cells grow into (and restore) the patient’s blood cells. The stem cell donor doesn’t have to be related to the patient. Stem cell transplant is rarely used as initial treatment for children and teenagers with ALL. It is used more often as part of treatment for ALL that relapses (comes back after treatment).
Relapsed Childhood Acute Lymphoblastic Leukemia
- Standard treatment of relapsed childhood acute lymphoblastic leukemia (ALL) that comes back in the bone marrow may include the following:
- Standard treatment of relapsed childhood acute lymphoblastic leukemia (ALL) that comes back outside the bone marrow may include the following:
Adapted from the National Cancer Institute’s Physician Data Query (PDQ(r)) Cancer Information Summaries (http://www.cancer.gov/
For more information:
Go to the Childhood Leukemia health topic.