Treatment Option Overview
Successful treatment of ALL consists of the control of bone marrow and systemic disease and the treatment (or prevention) of sanctuary-site disease, particularly the central nervous system (CNS).[1,2] The cornerstone of this strategy includes systemically administered combination chemotherapy with CNS preventive therapy. CNS prophylaxis is achieved with chemotherapy (intrathecal and/or high-dose systemic therapy) and, in some cases, cranial radiation therapy.
Treatment is divided into the following three phases:
- Remission induction.
- CNS prophylaxis.
- Postremission (also called remission continuation or maintenance).
The average length of treatment for ALL varies between 1.5 and 3 years in the effort to eradicate the leukemic cell population. Younger adults with ALL may be eligible for selected clinical trials for childhood ALL. (Refer to the PDQ summary on Childhood Acute Lymphoblastic Leukemia Treatment for more information.)
Entry into a clinical trial is highly desirable to assure adequate patient treatment and maximal information retrieval from the treatment of this highly responsive, but usually fatal, disease.
Table 2. Standard Treatment Options for Adult ALL| Disease Status | Standard Treatment Options |
| CNS = central nervous system. | |
| Untreated ALL | Remission induction therapy |
| CNS prophylaxis therapy | |
| ALL in remission | Postremission therapy |
| CNS prophylaxis therapy | |
| Recurrent ALL | Reinduction chemotherapy |
| Palliative radiation therapy | |
| Dasatinib | |
References
- Clarkson BD, Gee T, Arlin ZA, et al.: Current status of treatment of acute leukemia in adults: an overview of the Memorial experience and review of literature. Crit Rev Oncol Hematol 4 (3): 221-48, 1986. [PUBMED Abstract]
- Hoelzer D, Gale RP: Acute lymphoblastic leukemia in adults: recent progress, future directions. Semin Hematol 24 (1): 27-39, 1987. [PUBMED Abstract]
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