What are the general treatment principles for acute lymphoblastic leukemia (ALL)?

Updated: Jul 02, 2021
  • Author: Karen Seiter, MD; Chief Editor: Matthew C Foster, MD  more...
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Answer

Answer

Treatment recommendations for patients who are diagnosed with ALL include induction, consolidation, and maintenance therapy along with CNS prophylaxis, as follows [1, 2, 3, 4, 5] :

  • Patients receive induction therapy with combinations of drugs, including vincristine, prednisone, cyclophosphamide, doxorubicin, and asparaginase, which are given over 4-6 wk. 

  • Asparaginase products: L-asparaginase is no longer commercially available; other asparaginase products include asparaginase Erwinia chrysanthemiasparaginase Erwinia chrysanthemi recombinantcalaspargase pegol, or pegaspargase. Check specific protocol for precise asparaginase product and dose.

  • Patients then receive consolidation (intensification) with multiagent therapy, including cytarabine and methotrexate; there is no role for radiation or surgical treatment in the induction phase.

  • Maintenance therapy includes 6-mercaptopurine, methotrexate, steroids, and vincristine; intrathecal methotrexate is administered throughout.

  • Newer studies with intensive multiagent chemotherapy (eg, the CALGB [Cancer and Leukemia Group B]- 8811 and hyper-CVAD [hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone] regimens and the ALL-2 regimen) plus the addition of TKIs for Ph+ ALL and rituximab for CD20-positive ALL have resulted in 3-y survivals of 50% or more in adults.


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