Acute Lymphocytic Leukemia - Home Management

Treatment During Remission (Consolidation and Maintenance)

Consolidation and maintenance therapies follow induction and first remission. The goal of consolidation and maintenance therapies is to prevent a relapse.

Consolidation (Intensification) Therapy

Because there is a high risk of the cancer returning (relapsing) after the first phase of treatment (induction therapy), an additional course of treatment is given next. This is called consolidation therapy (also called intensification therapy). Consolidation is an intense chemotherapy regimen that is designed to prevent a relapse and usually continues for about 4 - 8 months.

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Examples of consolidation regimens for children at standard risk:

• A limited number of courses of intermediate- or high-dose methotrexate
• An anthracycline drug, such as daunorubicin (Cerubidine), used for reinduction followed by cyclophosphamide (Cytoxan, Neosar) 3 months after remission
• Extended use of an asparaginase drug.

More intense regimens are used for children at high-risk for relapse.

Maintenance

The last phase of treatment is maintenance (also called continuation therapy):

• Maintenance therapy typically uses weekly administration of methotrexate (usually in oral form) and daily doses of mercaptopurine.
• If children were not given CNS prophylaxis before, it may be given now.
• Vincristine and a corticosteroid drug (generally dexamethasone) may be added to standard maintenance therapy.

A maintenance regimen is usually less toxic and easier to tolerate than induction and consolidation. Maintenance treatment lasts for about 2 - 3 years for most patients with ALL. It is not clear if maintenance therapy benefits patients who have certain specific types of ALL leukemias, such as T-cell ALL or mature B-cell ALL (Burkitt leukemia).

Review Date: 01/27/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).