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Harvard Medical School

Acute Lymphocytic Leukemia (ALL) in Children

Treatment

Treatment of childhood ALL usually occurs in phases:

• First phase — induction therapy. The goal of this phase is to kill as many leukemia cells in the blood and bone marrow as possible.

• Second phase — consolidation therapy. The goal of this phase is to kill any leukemia cells that remain after induction therapy. These cells may not be active, but they could begin to grow later and cause a relapse.

• Third phase — maintenance therapy. The goal of this phase is the same as the second phase. However, the doses of drugs are often lower.

In addition, children with ALL usually receive therapy to prevent or treat leukemia in the brain and spinal cord.

Your child will have bone marrow aspirations and biopsies throughout treatment. These tests show how well the cancer is responding to treatment.

The type of treatment varies depending on the child's age, disease subtype, and risk group (standard/low risk or high risk). Four types of treatment are used for childhood ALL:

Chemotherapy is the most common treatment for ALL. It involves the use of one or more drugs to kill cancer cells or prevent them from dividing and growing. Chemotherapy drugs may be taken by mouth or injected into a vein or muscle. They travel through the bloodstream and body. Chemotherapy that goes directly into the spinal column may be used to treat ALL that has, or may, spread to the brain and spinal cord. (ALL cells can "hide" in and around the spinal canal and spinal cord.)

• Radiation therapy uses high-energy radiation to kill cancer cells or stop them from growing. The radiation can be delivered from a machine outside the body (external radiation therapy). Or, it can come from a radioactive substance put into the body, either in or near a cancer (internal radiation therapy). Because radiation therapy can affect the development of the brain, especially in younger children, the doctor may avoid using it to treat the brain. But it may be used in children with high risk ALL.

• Targeted therapy uses drugs to identify and attack cancer cells without affecting healthy cells. The drugs, called tyrosine kinase inhibitors, block an enzyme that drives the growth of cancers caused by specific genetic mutations. Imatinib (Gleevec) and dasatinib (Sprycel) are two such drugs.

• Chemotherapy with stem cell transplant replaces a person's blood-forming cells. This may be necessary if the cells are abnormal or have been destroyed by cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor. Once removed, they are frozen. The patient receives high-dose chemotherapy. The stored stem cells are then infused into the patient's bloodstream. These cells grow into normal blood cells. A stem cell transplant has significant short- and long-term side effects, so it's rarely the treatment of choice in children and teens. However, it may be used if the disease returns after it was initially treated.

Some children receiving ALL treatment experience no side effects, but others do. Side effects vary, depending on the treatment. They may include

• anemia (a lack of red blood cells)

• infection

• easy bleeding

• nausea

• mouth sores

• diarrhea

• hair loss.

There are many ways to manage side effects. For example, regular hand washing can help lower the risk of infection.

Your child will need regular checkups after he or she has finished treatment. Some of the tests done to diagnose ALL may be repeated to monitor your child's health and see whether the cancer has returned.