Medical Health Encyclopedia

Transplantation procedures do not appear to offer any additional advantages for patients at low or standard risk.

Chemotherapy Drugs Used After Relapse

Many different drugs are used to treat ALL relapses. These drugs include vincristine, L-asparaginase, anthracyclines (doxorubicin, daunorubicin), cyclophosphamide, cytarabine (ara-C), and epipodophyllotoxins (etoposide, teniposide). Corticosteroids, such as prednisone or dexamethasone, may also be used. Although it is not yet approved for ALL, many doctors use imatinib (Gleevec) to treat patients with the Philadelphia chromosome. In 2004, the FDA approved clofarabine (Clolar) for treatment of relapsed or refractory ALL in children. This drug was the first new leukemia treatment approved specifically for young patients in more than a decade. In 2005, nelarabine (Arranon) was approved to treat adults and children with relapsed or refractory T-cell acute lymphocytic leukemia (T-ALL).

Investigative Drugs

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Tyrosine kinase inhibitors. Tyrosine kinase is a growth-stimulating protein. Tyrosine kinase inhibitor drugs block the cell signals that trigger cancer growth. Several tyrosine kinase inhibitors are showing a great deal of promise in treating different types of ALL:

• Imatinib (Gleevec) has shown benefits in many studies as a first-line treatment for patients with Philadelphia chromosome positive ALL. The drug is currently approved to treat chronic myeloid leukemia (CLL). It is in Phase II trials for ALL.
• AMN-107 has produced excellent results in patients with Philadelphia chromosome positive ALL who are resistant to imatinib. Some experts predict that this drug will eventually become the standard of care for patients with this type of cancer. It is in Phase I/II trials.
• BMS-354825 has shown promise in Phase I trials as another treatment for patients with Philadelphia chromosome positive ALL. Like AMN-107, this drug blocks a type of tyrosine kinase called Bcr-Abl.