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A maintenance regimen is usually less toxic and easier to tolerate than induction and consolidation. Some studies, however, are showing that overall survival could further be improved with more-aggressive maintenance therapies, including:
- Vincristine and a corticosteroid added to the standard maintenance regimen.
- Longer term low-dose maintenance.
- Intense regimens similar to induction (called reinduction).
Maintenance typically continues until continuous complete remission has lasted 2 to 3 years.
Investigation is ongoing to determine the optimal drugs and schedules to use. For example, the drug thioguanine may be a more effective choice than mercaptopurine. Researchers are also trying to pinpoint patients who would best benefit from aggressive maintenance treatments.
Risk Factors for Relapse after a First Remission
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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 to 14 days of induction therapy
- The need for four 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.
Investigative Indicators for Predicting Relapse
A 2001 study suggested that test results showing elevated levels of a peptide called glutathione in blast cells may indicate a higher risk for relapse after treatment.
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