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Acute Lymphocytic Leukemia - Treatment During Remission

From DrKoop's partner site on breast cancer, MyBreastCancerNetwork.com

(Page 2)


  • Vincristine and a corticosteroid added to the standard maintenance regimen
  • Longer term low-dose maintenance
  • Intense regimens similar to induction (called reinduction)

Maintenance typically is ongiong until complete remission has lasted 2 - 3 years.

Investigation is ongoing to determine the best drugs and schedules to use. For example, doctors have debated whether thioguanine is a better choice than mercaptopurine (a 2006 study recommended that mercaptopurine remain the standard thiopurine drug for treating childhood ALL). Researchers are also trying to pinpoint patients who would best benefit from aggressive maintenance treatments.

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Risk Factors for Relapse after a First Remission

The following are factors that increase the risk for relapse after initial treatments:

  • Microscopic evidence of leukemia after 20 weeks of therapy (minimal disease)
  • Age over 30
  • A high white blood cell count at the time of diagnosis
  • Disease that has spread beyond the bone marrow to other organs
  • Certain genetic abnormalities, such as the presence of the Philadelphia chromosome or MLL gene translocations
  • Patients with high disease levels after 7 - 14 days of induction therapy
  • The need for 4 or more weeks of induction chemotherapy in order to achieve a first complete remission

Patients with one or more of these risk factors may be candidates for bone marrow transplantation once they are in first remission.

Review Date: 01/16/2007
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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