Treatment to Achieve Remission

The aim of induction therapy, the first phase, is to reduce the number of leukemia cells to undetectable levels. The general guidelines for induction therapy are as follows:

• Patients are given intensive chemotherapy that uses powerful multi-drug regimens. (Infants require special regimens not discussed here.)
• For both children and adults, some of these therapies are administered orally, others intravenously.
• Hospitalization is usually necessary at some point to help prevent infection and to administer blood products. However, much of this therapy can be given on an outpatient basis.
• After the first cycle of induction, bone marrow tests are done to determine if the patient is in remission.
• Another bone marrow test is sometimes done about a week later to confirm the first results.
• A bone marrow transplant is considered for patients who do not respond at all to induction treatment.

Drugs Used for Induction Chemotherapy

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Drugs Used for Standard or Low-Risk Patients. A three-drug regimen is typically used for standard or low-risk patients. (A fourth drug, such as cyclophosphamide, may be added for adult patients.) Examples of drugs used in regimens for children include:

• Vincristine
• Corticosteroids (prednisone or dexamethasone) --a 2003 study reported better survival rates with dexamethasone compared to prednisone.
• Asparaginase -- several forms are available. Investigation on a potent form called E-coli asparaginase (Asparaginase medac) is promising for preventing relapse, particularly second relapses, but this drug is very toxic and increases the risk for blood clots.