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Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®)

Health Professional Version

Changes to this Summary (12/17/2014)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Risk-Based Treatment Assignment

Added Lundin et al. as reference 53, Chilton et al. as reference 122, and Irving et al. as reference 132.

Revised text to state that a study by the Children's Oncology Group, which used intensive chemotherapy and concurrent imatinib mesylate given daily, demonstrated a 5-year event-free survival (EFS) rate of 70% ± 12%, which was superior to the EFS rate of historical controls in the pre-tyrosine kinase inhibitor (imatinib mesylate) era (cited Schultz et al. as reference 152).

Added text to state that modifying therapy based on minimal residual disease (MRD) determination has been shown to improve outcome in B-cell ALL. Also added text to state that in a randomized controlled trial, the UKALL2003 study also demonstrated improved EFS for standard-risk and intermediate-risk patients who received augmented therapy if end-induction MRD was greater than 0.01% (cited Vora et al. as reference 211).

Postinduction Treatment for Childhood ALL

Added text to state that the effects of end-induction and/or consolidation MRD on outcome has influenced the treatment of patients originally diagnosed as National Cancer Institute standard risk; multiple studies have demonstrated that higher levels of end-induction MRD are associated with poorer prognosis (cited Borowitz et al, van Dongen et al., Zhou et al., Coustan-Smith et al., and Stow et al. as references 13, 14, 15, 16, and 17, respectively). Also added text to state that augmenting therapy has been shown to improve the outcome in standard-risk patients with elevated MRD levels at the end of induction (cited Vora et al. as reference 18).

Added text to state that patients who are standard or intermediate risk at diagnosis, but have high levels of end-induction MRD, have been shown to have a poorer prognosis and should be treated as high-risk patients. The UKALL2003 study demonstrated in a randomized controlled trial that augmented postinduction therapy increases EFS to that comparable to patients with low levels of end-induction MRD.

Added text to state that a phase III clinical trial (POG-9406) was conducted in higher-risk pediatric B-precursor ALL patients. A total of 784 patients were randomly assigned to receive methotrexate, 1 g/m2 versus 2.5 g/m2; no differences in disease-free survival or overall survival were observed between 1 g/m2 and 2.5 g/m2 of methotrexate (cited Tower et al. as reference 34).

Revised text about the COG-AALL1131 trial to state that patients with very high-risk features are no longer eligible for enrollment on this study.

Postinduction Treatment for Specific ALL Subgroups

Added text to state that a retrospective study of 30 pediatric patients with Philadelphia chromosome–positive ALL indicated that tyrosine kinase inhibitors, when started mid-induction, are associated with lower end-induction MRD (cited Jeha et al. as reference 58).

Revised text to state that the 5-year EFS for the 25 patients who received intensive chemotherapy with continuous dosing of imatinib mesylate is 70% ± 12% (cited Schultz et al. as reference 59).

Treatment of Relapsed Childhood ALL

Added text to state that results from one study suggest that patients with a late marrow relapse who have high end-reinduction MRD may have a better outcome if they receive an allogeneic hematopoietic stem cell transplantation in second complete remission (cited Eckert et al. as reference 53).

The Role of GVHD/GVL in ALL and immune modulation after transplant to prevent relapse subsection was extensively revised.

This summary is written and maintained by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.

  • Updated: December 17, 2014