Acute Lymphocytic Leukemia - Treatment to Achieve Remission

Treatment After Relapse

Relapse is when cancer returns after remission. Most patients with ALL achieve remission after induction therapy, but in some patients the disease returns.

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.

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Treatment for relapse after a first remission may be standard chemotherapy or experimental drugs, or more aggressive treatments such as stem cell transplants.

The decision depends on a number of factors including how soon relapse occurs after treatment:

• Children who relapse 3 or more years after achieving a first complete remission usually achieve a second remission with a second round of standard chemotherapy treatments.
• Children who relapse within 6 months to 3 years following treatment may be able to achieve remission with a more aggressive course of chemotherapy.
• Children who relapse fewer than 6 months following initial treatment, or while on chemotherapy have a lower chance for a second remission. In such cases, stem cell transplantation may be considered. Stem cell transplantation is especially considered for children who relapse with T-cell ALL or precursor B-cell ALL.
• Adult patients with ALL who experience a relapse following maintenance therapy are unlikely to be helped by additional chemotherapy alone. They are considered candidates for stem cell transplantation. Stem cell transplantation is also an option for adults, but not children, who have achieved a first remission.

Transplantation procedures are reserved for patients with high-risk disease who are unlikely to achieve remission with chemotherapy alone. Transplantation does not offer any additional advantages for patients at low or standard risk.