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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65947_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65947_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65947_"><span class="title" itemprop="name">Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Pediatric Treatment Editorial Board</span>.</p><p class="small">Published online: August 17, 2017.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000258001__291">This PDQ cancer information summary has current information about the treatment of childhood acute lymphoblastic leukemia. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000258001__292">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.</p></div><div id="CDR0000258001__1"><h2 id="_CDR0000258001__1_">General Information About Childhood Acute Lymphoblastic
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||
Leukemia </h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258001__2">Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which
|
||
the bone marrow makes too many immature lymphocytes (a type of white blood cell).</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__275">Leukemia may affect red blood cells, white blood cells, and platelets.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__11">Past treatment for cancer and certain genetic conditions affect the risk of having childhood ALL.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__15">Signs of childhood ALL
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||
include fever and bruising.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__19">Tests that examine the blood and bone marrow are
|
||
used to detect (find) and diagnose childhood ALL.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__23">Certain factors affect prognosis (chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000258001__2"><h3>Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which
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the bone marrow makes too many immature lymphocytes (a type of white blood cell).</h3><p id="CDR0000258001__4">Childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (also called ALL or acute lymphocytic leukemia) is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>. This type of cancer usually gets worse quickly if it is not treated. </p><div id="CDR0000258001__285" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20bone&p=BOOKS&id=448306_CDR0000755927.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65947.13/bin/CDR0000755927.jpg" alt="Anatomy of the bone; drawing shows spongy bone, red marrow, and yellow marrow. A cross section of the bone shows compact bone and blood vessels in the bone marrow. Also shown are red blood cells, white blood cells, platelets, and a blood stem cell." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Anatomy of the bone. The bone is made up of compact bone, spongy bone, and bone marrow. Compact bone makes up the outer layer of the bone. Spongy bone is found mostly at the ends of bones and contains red marrow. Bone marrow is found in the center of most bones and has many blood vessels. There are two types of bone marrow: red and yellow. Red marrow contains blood stem cells that can become red blood cells, white blood cells, or platelets. Yellow marrow is made mostly of fat.</p></div></div><p id="CDR0000258001__245">ALL is the most common type of cancer in children.</p></div><div id="CDR0000258001__275"><h3>Leukemia may affect red blood cells, white blood cells, and platelets.</h3><p id="CDR0000258001__277">In a healthy child, the bone marrow makes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000765906/" class="def">blood stem cells</a> (immature <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>) that become mature blood cells over time. A blood stem cell may become a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046279/" class="def">myeloid</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cell</a> or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046298/" class="def">lymphoid</a> stem cell.</p><p id="CDR0000258001__278">A myeloid stem cell becomes one of three types of mature blood cells:</p><ul id="CDR0000258001__279"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">Red blood cells</a> that carry <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a> and other substances to all <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> of the
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body.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">Platelets</a> that form <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476017/" class="def">blood clots</a> to stop bleeding.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">White blood cells</a> that fight <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> and disease. </div></li></ul><p id="CDR0000258001__280">A lymphoid stem cell becomes a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302475/" class="def">lymphoblast</a> cell and then one of three types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045765/" class="def">lymphocytes</a> (white blood cells):</p><ul id="CDR0000258001__281"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044953/" class="def">B lymphocytes</a> that make <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to help fight infection.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T lymphocytes</a> that help B lymphocytes make the antibodies that help fight infection.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044062/" class="def">Natural killer cells</a> that attack cancer cells and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045941/" class="def">viruses</a>.</div></li></ul><div id="CDR0000258001__185" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Blood%20cell%20development&p=BOOKS&id=448306_CDR0000526538.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65947.13/bin/CDR0000526538.jpg" alt="Blood cell development; drawing shows the steps a blood stem cell goes through to become a red blood cell, platelet, or white blood cell. A myeloid stem cell becomes a red blood cell, a platelet, or a myeloblast, which then becomes a granulocyte (the types of granulocytes are eosinophils, basophils, and neutrophils). A lymphoid stem cell becomes a lymphoblast and then becomes a B-lymphocyte, T-lymphocyte, or natural killer cell." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Blood cell development. A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell. </p></div></div><p id="CDR0000258001__282">In a child with ALL, too many stem cells become lymphoblasts, B lymphocytes, or T lymphocytes. The cells do not work like normal lymphocytes and are not able to fight infection very well. These cells are cancer (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a>) cells. Also, as the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045360/" class="def">anemia</a>, and easy bleeding.</p><p id="CDR0000258001__283">This summary is about acute lymphoblastic leukemia in children, adolescents, and young adults. See the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summaries for information about other types of leukemia:</p><ul id="CDR0000258001__284"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258000/">Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000257989/">Adult Acute Lymphoblastic Leukemia Treatment</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258005/">Chronic Lymphocytic Leukemia Treatment</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000257990/">Adult Acute Myeloid Leukemia Treatment</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258006/">Chronic Myelogenous Leukemia Treatment</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258013/">Hairy Cell Leukemia Treatment</a></div></li></ul></div><div id="CDR0000258001__11"><h3>Past treatment for cancer and certain genetic conditions affect the risk of having childhood ALL.</h3><p id="CDR0000258001__13">Anything that increases your risk of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child's doctor if you think your child may be at risk. </p><p id="CDR0000258001__259">Possible risk factors for ALL include the following:</p><ul id="CDR0000258001__14"><li class="half_rhythm"><div>Being exposed to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> before birth.</div></li><li class="half_rhythm"><div>Being exposed to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a>.</div></li><li class="half_rhythm"><div>Past treatment with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div>Having certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444994/" class="def">genetic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>, such as:<dl id="CDR0000258001__258" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045488/" class="def">Down syndrome</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045096/" class="def">Neurofibromatosis type 1</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666662/" class="def">Bloom syndrome</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045499/" class="def">Fanconi anemia</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270853/" class="def">Ataxia-telangiectasia</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046322/" class="def">Li-Fraumeni syndrome</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Constitutional mismatch repair deficiency (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046063/" class="def">mutations</a> in certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a> that stop <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> from repairing itself, which leads to the growth of cancers at an early age).</p></dd></dl></div></li><li class="half_rhythm"><div>Having certain changes in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosomes</a> or genes.</div></li></ul></div><div id="CDR0000258001__15"><h3>Signs of childhood ALL
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include fever and bruising.</h3><p id="CDR0000258001__17">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by childhood ALL or by other conditions. Check with your child's doctor if your child has any of the following:</p><ul id="CDR0000258001__18"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a>.</div></li><li class="half_rhythm"><div>Easy bruising or bleeding.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046236/" class="def">Petechiae</a> (flat, pinpoint, dark-red spots under the skin caused by bleeding).</div></li><li class="half_rhythm"><div>Bone or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000458080/" class="def">joint</a> pain.</div></li><li class="half_rhythm"><div>Painless lumps in the neck, underarm, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>.</div></li><li class="half_rhythm"><div>Pain or feeling of fullness below the ribs.</div></li><li class="half_rhythm"><div>Weakness, feeling tired, or looking pale.</div></li><li class="half_rhythm"><div>Loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a>.</div></li></ul></div><div id="CDR0000258001__19"><h3>Tests that examine the blood and bone marrow are
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used to detect (find) and diagnose childhood ALL.</h3><p id="CDR0000258001__21">The following tests and procedures may be used to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> childhood ALL and find out if leukemia cells have spread to other parts of the body such as the brain or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a>:</p><ul id="CDR0000258001__22"><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000729979/" class="def">Complete blood count (CBC) with differential</a></b>: A procedure in which a sample of blood is drawn and checked for the following:<ul id="CDR0000258001__82"><li class="half_rhythm"><div>The number of red blood cells and platelets.</div></li><li class="half_rhythm"><div>The number and type of white blood cells.</div></li><li class="half_rhythm"><div>The amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045108/" class="def">hemoglobin</a> (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> that carries oxygen) in the red blood cells.</div></li><li class="half_rhythm"><div>The portion of the sample made up of red blood cells.</div></li></ul><div id="CDR0000258001__172" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Complete%20blood%20count%20(CBC)&p=BOOKS&id=448306_CDR0000526546.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65947.13/bin/CDR0000526546.jpg" alt="Complete blood count (CBC); left panel shows blood being drawn from a vein on the inside of the elbow using a tube attached to a syringe; right panel shows a laboratory test tube with blood cells separated into layers: plasma, white blood cells, platelets, and red blood cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.</p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry studies</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046505/" class="def">Bone marrow aspiration</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046506/" class="def">biopsy</a></b>: The removal of bone marrow and a small piece of bone by inserting a hollow needle into the hipbone or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000549425/" class="def">breastbone</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the bone marrow and bone under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for signs of cancer.<div id="CDR0000258001__293" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Bone%20marrow%20aspiration%20and%20biopsy&p=BOOKS&id=448306_CDR0000775458.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65947.13/bin/CDR0000775458.jpg" alt="Bone marrow aspiration and biopsy; drawing shows a child lying face down on a table and a bone marrow needle being inserted into the right hip bone. An inset shows the bone marrow needle being inserted through the skin into the bone marrow of the hip bone." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Bone marrow aspiration and biopsy. After a small area of skin is numbed, a bone marrow needle is inserted into the child’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.</p></div></div></div><div class="half_rhythm">The following tests are done on blood or the bone marrow tissue that is removed:<ul id="CDR0000258001__261"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270737/" class="def">Cytogenetic analysis</a></b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> in which the cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes of lymphocytes. For example, in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044179/" class="def">Philadelphia chromosome</a>–positive ALL, part of one chromosome switches places with part of another chromosome. This is called the “Philadelphia chromosome.” <div id="CDR0000258001__173" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Philadelphia%20chromosome&p=BOOKS&id=448306_CDR0000533336.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65947.13/bin/CDR0000533336.jpg" alt="Philadelphia chromosome; three-panel drawing shows a piece of chromosome 9 and a piece of chromosome 22 breaking off and trading places, creating a changed chromosome 22 called the Philadelphia chromosome. In the left panel, the drawing shows a normal chromosome 9 with the abl gene and a normal chromosome 22 with the bcr gene. In the center panel, the drawing shows chromosome 9 breaking apart in the abl gene and chromosome 22 breaking apart below the bcr gene. In the right panel, the drawing shows chromosome 9 with the piece from chromosome 22 attached and chromosome 22 with the piece from chromosome 9 containing part of the abl gene attached. The changed chromosome 22 with bcr-abl gene is called the Philadelphia chromosome." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Philadelphia chromosome. A piece of chromosome 9 and a piece of chromosome 22 break off and trade places. The bcr-abl gene is formed on chromosome 22 where the piece of chromosome 9 attaches. The changed chromosome 22 is called the Philadelphia chromosome.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000341450/" class="def">Immunophenotyping</a></b>: A laboratory test in which the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> or markers on the surface of a blood or bone marrow cell are checked to see if they are lymphocytes or myeloid cells. If the cells are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a> lymphocytes (cancer) they are checked to see if they are B lymphocytes or T lymphocytes.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046303/" class="def">Lumbar puncture</a></b>: A procedure used to collect a sample of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (CSF) from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000396787/" class="def">spinal column</a>. This is done by placing a needle between two bones in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a> and into the CSF around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a> and removing a sample of the fluid. The sample of CSF is checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> for signs that leukemia cells have spread to the brain and spinal cord. This procedure is also called an LP or spinal tap.<div id="CDR0000258001__272" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Lumbar%20puncture&p=BOOKS&id=448306_CDR0000503953.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65947.13/bin/CDR0000503953.jpg" alt="Lumbar puncture; drawing shows a patient lying in a curled position on a table and a spinal needle (a long, thin needle) being inserted into the lower back. Inset shows a close-up of the spinal needle inserted into the cerebrospinal fluid (CSF) in the lower part of the spinal column." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Lumbar puncture. A patient lies in a curled position on a table. After a small area on the lower back is numbed, a spinal needle (a long, thin needle) is inserted into the lower part of the spinal column to remove cerebrospinal fluid (CSF, shown in blue). The fluid may be sent to a laboratory for testing.</p></div></div></div><div class="half_rhythm">This procedure is done after leukemia is diagnosed to find out if leukemia cells have spread to the brain and spinal cord. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">Intrathecal chemotherapy</a> is given after the sample of fluid is removed to treat any leukemia cells that may have spread to the brain and spinal cord. </div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">Chest x-ray</a></b>: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. The chest x-ray is done to see if leukemia cells have formed a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638197/" class="def">mass</a> in the middle of the chest.</div></li></ul></div><div id="CDR0000258001__23"><h3>Certain factors affect prognosis (chance of recovery) and treatment options.</h3><p id="CDR0000258001__98">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) depends on:</p><ul id="CDR0000258001__124"><li class="half_rhythm"><div>How quickly and how low the leukemia cell count drops after the first month of treatment.</div></li><li class="half_rhythm"><div>Age at the time of diagnosis, sex, race, and ethnic background.</div></li><li class="half_rhythm"><div>The number of white blood cells in the blood at the time of diagnosis.</div></li><li class="half_rhythm"><div>Whether the leukemia cells began from B lymphocytes or T lymphocytes.</div></li><li class="half_rhythm"><div>Whether there are certain changes in the chromosomes or genes of the lymphocytes with cancer.</div></li><li class="half_rhythm"><div>Whether the child has Down syndrome.</div></li><li class="half_rhythm"><div>Whether leukemia cells are found in the cerebrospinal fluid.</div></li><li class="half_rhythm"><div>The child's weight at the time of diagnosis and during treatment.</div></li></ul><p id="CDR0000258001__228">Treatment options depend on:</p><ul id="CDR0000258001__229"><li class="half_rhythm"><div>Whether the leukemia cells began from B lymphocytes or T lymphocytes.</div></li><li class="half_rhythm"><div>Whether the child has standard-risk, high-risk, or very high–risk ALL.</div></li><li class="half_rhythm"><div>The age of the child at the time of diagnosis.</div></li><li class="half_rhythm"><div>Whether there are certain changes in the chromosomes of lymphocytes, such as the Philadelphia chromosome.</div></li><li class="half_rhythm"><div>Whether the child was treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046601/" class="def">steroids</a> before the start of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045736/" class="def">induction therapy</a>.</div></li><li class="half_rhythm"><div>How quickly and how low the leukemia cell count drops during treatment.</div></li></ul><p id="CDR0000258001__202">For leukemia that <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045866/" class="def">relapses</a> (comes back) after treatment, the prognosis and treatment options depend partly on the following:</p><ul id="CDR0000258001__203"><li class="half_rhythm"><div>How long it is between the time of diagnosis and when the leukemia comes back.</div></li><li class="half_rhythm"><div>Whether the leukemia comes back in the bone marrow or in other parts of the body.</div></li></ul></div></div><div id="CDR0000258001__26"><h2 id="_CDR0000258001__26_">Risk Groups for Childhood Acute Lymphoblastic Leukemia</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258001__121">In childhood ALL, risk groups are used to plan treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__301">Relapsed childhood ALL is cancer that has
|
||
come back after it has been treated.</a></div></li></ul></div><div id="CDR0000258001__121"><h3>In childhood ALL, risk groups are used to plan treatment.</h3><p id="CDR0000258001__123">There are three <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693559/" class="def">risk groups</a> in childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044362/" class="def">ALL</a>. They are described as:</p><ul id="CDR0000258001__87"><li class="half_rhythm"><div>Standard (low) risk: Includes children aged 1 to younger than 10 years who have a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cell</a> count of less than 50,000/µL at the time of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosis</a>.</div></li><li class="half_rhythm"><div>High risk: Includes children 10 years and older and/or children who have a white blood cell count of 50,000/µL or more at the time of diagnosis.</div></li><li class="half_rhythm"><div>Very high risk: Includes children younger than age 1, children with certain changes in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a>, children who have a slow <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">response</a> to initial treatment, and children who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> after the first 4 weeks of treatment.</div></li></ul><p id="CDR0000258001__88">Other factors that affect the risk group include the following:</p><ul id="CDR0000258001__205"><li class="half_rhythm"><div>Whether the leukemia <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> began from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044953/" class="def">B lymphocytes</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000467345/" class="def">T lymphocytes</a>.</div></li><li class="half_rhythm"><div>Whether there are certain changes in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosomes</a> or genes of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045765/" class="def">lymphocytes</a>.</div></li><li class="half_rhythm"><div>How quickly and how low the leukemia cell count drops after initial treatment.</div></li><li class="half_rhythm"><div>Whether leukemia cells are found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> at the time of diagnosis.</div></li></ul><p id="CDR0000258001__206">It is important to know the risk group in order to plan treatment. Children with high-risk or very high–risk ALL usually receive more anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> and/or higher <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of anticancer drugs than children with standard-risk ALL. </p></div><div id="CDR0000258001__301"><h3>Relapsed childhood ALL is cancer that has
|
||
come back after it has been treated.</h3><p id="CDR0000258001__303">The leukemia may come back in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>, brain, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a>, or other parts of the body.</p><p id="CDR0000258001__308"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350245/" class="def">Refractory</a> childhood ALL is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that does not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">respond</a> to treatment.</p></div></div><div id="CDR0000258001__32"><h2 id="_CDR0000258001__32_">Treatment Option Overview</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258001__33">There are different types of treatment for childhood acute
|
||
lymphoblastic leukemia (ALL). </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__37">Children with ALL should have their
|
||
treatment planned by a team of doctors who are experts in treating childhood
|
||
leukemia.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__294">Children and adolescents may have treatment-related side effects that appear months or years after treatment for acute lymphoblastic leukemia.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__104">The treatment of childhood ALL usually has three phases.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__42">Four types of standard treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258001__44">Chemotherapy </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__48">Radiation therapy
|
||
</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__127">Chemotherapy with stem cell transplant</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__208">Targeted therapy </a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258001__249">Treatment is given to kill leukemia cells that have spread or may spread to the brain, spinal cord, or testicles.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__52">New types of treatment are being tested in clinical trials.
|
||
</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__177">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__179">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258001__181">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000258001__33"><h3>There are different types of treatment for childhood acute
|
||
lymphoblastic leukemia (ALL). </h3><p id="CDR0000258001__35">Different types of treatment are available for children with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute
|
||
lymphoblastic leukemia</a> (ALL). Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used
|
||
treatment), and some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical
|
||
trials</a>. A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to
|
||
help improve current treatments or obtain information on new treatments for
|
||
patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical
|
||
trials show that a new treatment is better than the
|
||
standard treatment, the new
|
||
treatment may become the standard treatment.</p><p id="CDR0000258001__36">Because cancer in children is rare, taking part in a clinical trial
|
||
should be considered. Some clinical trials are open only to patients who have not started treatment.</p></div><div id="CDR0000258001__37"><h3>Children with ALL should have their
|
||
treatment planned by a team of doctors who are experts in treating childhood
|
||
leukemia.</h3><p id="CDR0000258001__39">Treatment will be overseen by a
|
||
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693555/" class="def">pediatric
|
||
oncologist</a>, a doctor who specializes
|
||
in treating children with cancer. The pediatric oncologist works with other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046245/" class="def">pediatric</a> health professionals who are experts in treating children
|
||
with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> and who specialize in certain areas of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a>. These may
|
||
include the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a>:</p><ul id="CDR0000258001__40"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000757278/" class="def">Pediatrician</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046370/" class="def">Hematologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046290/" class="def">Medical
|
||
oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318823/" class="def">Pediatric surgeon</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">Radiation
|
||
oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046267/" class="def">Neurologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">Pathologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046551/" class="def">Radiologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318821/" class="def">Pediatric nurse specialist</a>.</div></li><li class="half_rhythm"><div>
|
||
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044730/" class="def">Social worker</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318825/" class="def">Rehabilitation specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044716/" class="def">Psychologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000690737/" class="def">Child-life specialist</a>.</div></li></ul></div><div id="CDR0000258001__294"><h3>Children and adolescents may have treatment-related side effects that appear months or years after treatment for acute lymphoblastic leukemia.</h3><p id="CDR0000258001__296"> Regular <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> exams are very important. Treatment can cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> long after it has ended. These are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>.</p><p id="CDR0000258001__297">Late effects of cancer treatment may include:</p><ul id="CDR0000258001__298"><li class="half_rhythm"><div>Physical problems, including problems with the heart, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, or bones, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046399/" class="def">fertility</a>. When <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045220/" class="def">dexrazoxane</a> is given with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>
|
||
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044916/" class="def">anthracyclines</a>, the risk of late heart effects is lessened.</div></li><li class="half_rhythm"><div>Changes in mood, feelings, thinking, learning, or memory. Children younger than 4 years who have received <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the brain have a higher risk of these effects.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">Second cancers</a> (new types of cancer) or other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000387264/" class="def">brain tumors</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445091/" class="def">thyroid cancer</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046347/" class="def">acute myeloid leukemia</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045266/" class="def">myelodysplastic syndrome</a>.</div></li></ul><p id="CDR0000258001__299">Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a>.</p></div><div id="CDR0000258001__104"><h3>The treatment of childhood ALL usually has three phases.</h3><p id="CDR0000258001__106">The treatment of childhood ALL is done in phases:</p><ul id="CDR0000258001__91"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046560/" class="def">Remission induction</a>: This is the first phase of treatment. The goal is to kill the leukemia <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>. This puts the leukemia into <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a>. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">Consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification</a>: This is the second phase of treatment. It begins once the leukemia is in remission. The goal of consolidation/intensification therapy is to kill any leukemia cells that remain in the body and may cause a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045866/" class="def">relapse</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045768/" class="def">Maintenance</a>: This is the third phase of treatment. The goal is to kill any remaining leukemia cells that may regrow and cause a relapse. Often the cancer treatments are given in lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> than those used during the remission induction and consolidation/intensification phases. Not taking medication as ordered by the doctor during maintenance therapy increases the chance the cancer will come back. This is also called the continuation therapy phase. </div></li></ul></div><div id="CDR0000258001__42"><h3>Four types of standard treatment are used:</h3><div id="CDR0000258001__44"><h4>Chemotherapy </h4><p id="CDR0000258001__73">Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (intrathecal), an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> is treatment using more than one anticancer drug. </p><p id="CDR0000258001__244">The way the chemotherapy is given depends on the child's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693559/" class="def">risk group</a>. Children with high-risk ALL receive more anticancer drugs and higher doses of anticancer drugs than children with standard-risk ALL. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">Intrathecal chemotherapy</a> may be used to treat childhood ALL that has spread, or may spread, to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>.</p><p id="CDR0000258001__215">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Lymphoblastic Leukemia</a> for more information.</p></div><div id="CDR0000258001__48"><h4>Radiation therapy
|
||
</h4><p id="CDR0000258001__74">Radiation therapy is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are two types of radiation therapy:</p><ul id="CDR0000258001__300"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000258001__290">The way the radiation therapy is given depends on the type of cancer being treated. External radiation therapy may be used to treat childhood ALL that has spread, or may spread, to the brain, spinal cord, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a>. It may also be used to prepare the bone marrow for a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</p></div><div id="CDR0000258001__127"><h4>Chemotherapy with stem cell transplant</h4><p id="CDR0000258001__129">Stem cell transplant is a method of giving high doses of chemotherapy and sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">total-body irradiation</a>, and then replacing the blood-forming cells destroyed by the cancer treatment. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">Stem cells</a> (immature blood cells) are removed from the blood or bone marrow of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a>. After the patient receives treatment, the donor's stem cells are given to the patient through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. These reinfused stem cells grow into (and restore) the patient's blood cells. The stem cell donor doesn't have to be related to the patient.</p><p id="CDR0000258001__207">Stem cell transplant is rarely used as initial treatment for children and adolescents with ALL. It is used more often as part of treatment for ALL that relapses (comes back after treatment).</p><p id="CDR0000258001__218">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Lymphoblastic Leukemia</a> for more information.</p><div id="CDR0000258001__286" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stem%20cell%20transplant&p=BOOKS&id=448306_CDR0000765030.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65947.13/bin/CDR0000765030.jpg" alt="Stem cell transplant; (Panel 1): Drawing of stem cells being removed from a patient or donor. Blood is collected from a vein in the arm and flows through a machine that removes the stem cells; the remaining blood is returned to a vein in the other arm. (Panel 2): Drawing of a health care provider giving a patient treatment to kill blood-forming cells. Chemotherapy is given to the patient through a catheter in the chest. (Panel 3): Drawing of stem cells being given to the patient through a catheter in the chest." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stem cell transplant. (Step 1): Blood is taken from a vein in the arm of the donor. The blood flows through a machine that removes the stem cells. Then the blood is returned to the donor through a vein in the other arm. (Step 2): The patient receives chemotherapy to kill blood-forming cells. The patient may receive radiation therapy (not shown). (Step 3): The patient receives stem cells through a catheter placed into a blood vessel in the chest.</p></div></div></div><div id="CDR0000258001__208"><h4>Targeted therapy </h4><p id="CDR0000258001__210"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. </p><p id="CDR0000258001__211"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">Tyrosine kinase inhibitors</a> (TKIs) are targeted therapy drugs that block the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a>, tyrosine kinase, which causes stem cells to become more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046503/" class="def">blasts</a> than the body needs. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">Imatinib mesylate</a> is a TKI used in the treatment of children with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044179/" class="def">Philadelphia chromosome</a>–positive ALL. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000484435/" class="def">Dasatinib</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000718942/" class="def">ruxolitinib</a> are TKIs that are being studied in the treatment of newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> high-risk ALL.</p><p id="CDR0000258001__313"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibody</a> therapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> made in the laboratory, from a single type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046622/" class="def">toxins</a>, or radioactive material directly to cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767205/" class="def">Blinatumomab</a> and inotuzumab are monoclonal antibodies being studied in the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350245/" class="def">refractory</a> childhood ALL.</p><p id="CDR0000258001__248">New kinds of targeted therapies are also being studied in the treatment of childhood ALL.</p><p id="CDR0000258001__216">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Lymphoblastic Leukemia</a> for more information.</p></div></div><div id="CDR0000258001__249"><h3>Treatment is given to kill leukemia cells that have spread or may spread to the brain, spinal cord, or testicles.</h3><p id="CDR0000258001__251">Treatment to kill leukemia cells or prevent the spread of leukemia cells to the brain and spinal cord (central nervous system; <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045643/" class="def">CNS</a>) is called CNS-directed therapy. Chemotherapy may be used to treat
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leukemia cells that have spread, or may spread, to the brain and spinal cord. Because standard doses of chemotherapy may not reach leukemia cells in the CNS, the cells are able to hide in the CNS. Systemic chemotherapy given in high doses or intrathecal chemotherapy (into the cerebrospinal fluid) is able to reach leukemia cells in the CNS. Sometimes external radiation therapy to the brain is also given.</p><div id="CDR0000258001__273" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Intrathecal%20chemotherapy&p=BOOKS&id=448306_CDR0000539773.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65947.13/bin/CDR0000539773.jpg" alt="Intrathecal chemotherapy; drawing shows the cerebrospinal fluid (CSF) in the brain and spinal cord, and an Ommaya reservoir (a dome-shaped container that is placed under the scalp during surgery; it holds the drugs as they flow through a small tube into the brain). Top section shows a syringe and needle injecting anticancer drugs into the Ommaya reservoir. Bottom section shows a syringe and needle injecting anticancer drugs directly into the cerebrospinal fluid in the lower part of the spinal column." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Intrathecal chemotherapy. Anticancer drugs are injected into the intrathecal space, which is the space that holds the cerebrospinal fluid (CSF, shown in blue). There are two different ways to do this. One way, shown in the top part of the figure, is to inject the drugs into an Ommaya reservoir (a dome-shaped container that is placed under the scalp during surgery; it holds the drugs as they flow through a small tube into the brain). The other way, shown in the bottom part of the figure, is to inject the drugs directly into the CSF in the lower part of the spinal column, after a small area on the lower back is numbed. </p></div></div><p id="CDR0000258001__252">These treatments are given in addition to treatment that is used to kill leukemia cells in the rest of the body. All children with ALL receive CNS-directed therapy as part of induction therapy and consolidation/intensification therapy and sometimes during maintenance therapy. </p><p id="CDR0000258001__253">If the leukemia cells spread to the testicles, treatment includes high doses of systemic chemotherapy and sometimes radiation therapy.</p></div><div id="CDR0000258001__52"><h3>New types of treatment are being tested in clinical trials.
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</h3><p id="CDR0000258001__176">This summary section describes treatments that are being
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studied in
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>.
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It may not mention every new treatment being studied. Information about clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000258001__289"><h4>Chimeric antigen receptor (CAR) T-cell therapy</h4><p id="CDR0000258001__288"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000771302/" class="def">CAR T-cell therapy</a> is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> that changes the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T cells</a> (a type of immune system cell) so they will attack certain proteins on the surface of cancer cells. T cells are taken from the patient and special <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044958/" class="def">receptors</a> are added to their surface in the laboratory. The changed cells are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000613507/" class="def">chimeric</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigen</a> receptor (CAR) T cells. The CAR T cells are grown in the laboratory and given to the patient by infusion. The CAR T cells multiply in the patient's blood and attack cancer cells. CAR T-cell therapy is being studied in the treatment of childhood ALL that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045866/" class="def">relapsed</a> (come back) a second time.</p></div></div><div id="CDR0000258001__177"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000258001__177_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000258001__177_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000258001__177_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000258001__179"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000258001__179_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000258001__179_30">Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044267/" class="def">NCI's</a> listing of clinical trials. </p></div><div id="CDR0000258001__181"><h3>Follow-up tests may be needed.</h3><p id="CDR0000258001__181_55">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000258001__181_56">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p><p id="CDR0000258001__247"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046505/" class="def">Bone marrow aspiration</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046506/" class="def">biopsy</a> is done during all phases of treatment to see how well the treatment is working. </p></div></div><div id="CDR0000258001__76"><h2 id="_CDR0000258001__76_">Treatment Options for Childhood Acute Lymphoblastic
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Leukemia</h2><div id="CDR0000258001__62"><h3>Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (Standard Risk)</h3><p id="CDR0000258001__165">The treatment of standard-risk childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (ALL) during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046560/" class="def">remission induction</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045768/" class="def">maintenance</a> phases always includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>. When children are in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a> after remission induction therapy, a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cells</a> from a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a> may be done. When children are not in remission after remission induction therapy, further treatment is usually the same treatment given to children with <a href="#CDR0000258001__262">high-risk ALL</a>.</p><p id="CDR0000258001__236"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">Intrathecal chemotherapy</a> is given to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439419/" class="def">prevent</a> the spread of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>.</p><p id="CDR0000258001__274">Treatments being studied in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for standard-risk ALL include new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimens</a>.</p><p id="CDR0000258001__TrialSearch_62_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258001__262"><h3>Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (High Risk)</h3><p id="CDR0000258001__263">The treatment of high-risk childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (ALL) during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046560/" class="def">remission induction</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045768/" class="def">maintenance</a> phases always includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>. Children in the high-risk ALL group are given more anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> and higher <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of anticancer drugs, especially during the consolidation/intensification phase, than children in the standard-risk group.</p><p id="CDR0000258001__264"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">Intrathecal</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a> are given to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439419/" class="def">prevent</a> or treat the spread of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>. Sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the brain is also given.</p><p id="CDR0000258001__265">Treatments being studied in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for high-risk ALL include new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimens</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</p><p id="CDR0000258001__TrialSearch_262_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258001__304"><h3>Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (Very High Risk)</h3><p id="CDR0000258001__305">The treatment of very high–risk childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (ALL) during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046560/" class="def">remission induction</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045768/" class="def">maintenance</a> phases always includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>. Children in the very high–risk ALL group are given more anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> than children in the high-risk group. It is not clear whether a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> during first <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a> will help the child live longer.</p><p id="CDR0000258001__306"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">Intrathecal</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a> are given to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439419/" class="def">prevent</a> or treat the spread of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>. Sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the brain is also given.</p><p id="CDR0000258001__307">Treatments being studied in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for very high–risk ALL include new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimens</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a>.</p><p id="CDR0000258001__TrialSearch_304_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258001__143"><h3>Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (Special Groups)</h3><div id="CDR0000258001__254"><h4>T-cell childhood acute lymphoblastic leukemia</h4><p id="CDR0000258001__144">The treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T-cell</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (ALL) during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046560/" class="def">remission induction</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045768/" class="def">maintenance</a> phases always includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>. Children with T-cell ALL are given more anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> and higher <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of anticancer drugs than children in the newly diagnosed standard-risk group.</p><p id="CDR0000258001__238"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">Intrathecal</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a> are given to prevent the spread of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>. Sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the brain is also given.</p><p id="CDR0000258001__266">Treatments being studied in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for T-cell ALL include new anticancer agents and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimens</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a>.</p></div><div id="CDR0000258001__255"><h4>Infants with ALL</h4><p id="CDR0000258001__195">The treatment of infants with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044362/" class="def">ALL</a> during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046560/" class="def">remission induction</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045768/" class="def">maintenance</a> phases always includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>. Infants with ALL are given different anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> and higher <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of anticancer drugs than children 1 year and older in the standard-risk group. It is not clear whether a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> during first <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a> will help the child live longer.</p><p id="CDR0000258001__267"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">Intrathecal</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a> are given to prevent the spread of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>. </p><p id="CDR0000258001__268">Treatments being studied in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for infants with ALL include the following:</p><ul id="CDR0000258001__196"><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> followed by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a> stem cell transplant for infants with certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a> changes. </div></li></ul></div><div id="CDR0000258001__256"><h4>Children 10 years and older and adolescents with ALL</h4><p id="CDR0000258001__197">The treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044362/" class="def">ALL</a> in children and adolescents (10 years and older) during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046560/" class="def">remission induction</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045768/" class="def">maintenance</a> phases always includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>. Children 10 years and older and adolescents with ALL are given more anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> and higher <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of anticancer drugs than children in the standard-risk group.</p><p id="CDR0000258001__269"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">Intrathecal</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a> are given to prevent the spread of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a>
|
||
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>. Sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the brain is also given.</p><p id="CDR0000258001__270">Treatments being studied in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for children 10 years and older and adolescents with ALL include new anticancer agents and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>
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||
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimens</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a>.</p></div><div id="CDR0000258001__257"><h4>Philadelphia chromosome–positive ALL</h4><p id="CDR0000258001__199">The treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044179/" class="def">Philadelphia chromosome</a>–positive childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044362/" class="def">ALL</a> during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046560/" class="def">remission induction</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045768/" class="def">maintenance</a> phases may include the following:</p><ul id="CDR0000258001__213"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">tyrosine kinase inhibitor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">imatinib mesylate</a>) with or without a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cells</a> from a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a>.</div></li></ul><p id="CDR0000258001__TrialSearch_143_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000258001__309"><h3>Refractory Childhood Acute Lymphoblastic Leukemia</h3><p id="CDR0000258001__310">There is no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a> for the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350245/" class="def">refractory</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (ALL). </p><p id="CDR0000258001__311">Some of the treatments being studied in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for refractory childhood ALL include:</p><ul id="CDR0000258001__312"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767205/" class="def">blinatumomab</a> or inotuzumab). </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000771301/" class="def">Chimeric antigen receptor (CAR) T-cell therapy</a>.</div></li></ul></div><div id="CDR0000258001__69"><h3>Relapsed Childhood Acute Lymphoblastic
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Leukemia</h3><p id="CDR0000258001__116"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatment</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045866/" class="def">relapsed</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (ALL) that comes back in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> may include the following:</p><ul id="CDR0000258001__117"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">total-body irradiation</a> followed by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>, using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cells</a> from a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a>.</div></li></ul><p id="CDR0000258001__200">Standard treatment of relapsed childhood acute lymphoblastic leukemia (ALL) that comes back outside the bone marrow may include the following:</p><ul id="CDR0000258001__201"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">Systemic chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">intrathecal chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the brain and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that comes back in the brain and spinal cord only.</div></li><li class="half_rhythm"><div>Combination chemotherapy and radiation therapy for cancer that comes back in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a> only.</div></li><li class="half_rhythm"><div>Stem cell transplant for cancer that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> in the brain and/or spinal cord.</div></li></ul><p id="CDR0000258001__118">Some of the treatments being studied in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for relapsed childhood ALL include:</p><ul id="CDR0000258001__119"><li class="half_rhythm"><div>New anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> and new combination chemotherapy treatments.</div></li><li class="half_rhythm"><div>Combination chemotherapy and new kinds of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapies</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767205/" class="def">blinatumomab</a> or inotuzumab). </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000771301/" class="def">Chimeric antigen receptor (CAR) T-cell therapy</a>.</div></li></ul><p id="CDR0000258001__TrialSearch_69_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000258001__169"><h2 id="_CDR0000258001__169_">To Learn More About Childhood Acute Lymphoblastic Leukemia</h2><p id="CDR0000258001__170">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about childhood acute lymphoblastic leukemia, see the following:</p><ul id="CDR0000258001__217"><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/wyntk-leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">What You Need to Know About™ Leukemia
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</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/ct-scans-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Computed Tomography (CT) Scans and Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/drugs/leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Lymphoblastic Leukemia</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant/stem-cell-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Blood-Forming Stem Cell Transplants</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Cancer Therapies</a></div></li></ul><p id="CDR0000258001__169_44">For more childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other general cancer resources, see the following:</p><ul id="CDR0000258001__169_45"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Childhood Cancers</a>
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</div></li><li class="half_rhythm"><div><a href="http://www.curesearch.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CureSearch for Children's Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/aya" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Adolescents and Young Adults with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/guide-for-parents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Children with Cancer: A Guide for Parents</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer in Children and Adolescents</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000258001__AboutThis_1"><h2 id="_CDR0000258001__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000258001__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000258001__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000258001__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000258001__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000258001__AboutThis_6">This PDQ cancer information summary has current information about the treatment of childhood acute lymphoblastic leukemia. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000258001__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000258001__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
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</p><p id="CDR0000258001__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>.
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</p></div><div id="CDR0000258001__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000258001__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000258001__AboutThis_12">Clinical trials are listed in PDQ and can be found online at <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000258001__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000258001__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000258001__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000258001__AboutThis_21">PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Acute Lymphoblastic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389385]</p><p id="CDR0000258001__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 scientific images.
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</p></div><div id="CDR0000258001__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000258001__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000258001__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000258001__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65947.13/?report=reader">PubReader</a></li><li><a href="/books/NBK65947.13/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65947" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65947" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Pediatric Treatment Editorial Board. Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Patient Version. 2017 Aug 17. In: PDQ Cancer Information Summaries [Internet]. 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Leukemia </a></li><li><a href="#CDR0000258001__26" ref="log$=inpage&link_id=inpage">Risk Groups for Childhood Acute Lymphoblastic Leukemia</a></li><li><a href="#CDR0000258001__32" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000258001__76" ref="log$=inpage&link_id=inpage">Treatment Options for Childhood Acute Lymphoblastic
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Leukemia</a></li><li><a href="#CDR0000258001__169" ref="log$=inpage&link_id=inpage">To Learn More About Childhood Acute Lymphoblastic Leukemia</a></li><li><a href="#CDR0000258001__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65763/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide 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xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31909939" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Chordoma (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Chordoma (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389279" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Rhabdomyosarcoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Rhabdomyosarcoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31909947" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Melanoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Melanoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389377" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Acute Myeloid Leukemia Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Acute Myeloid Leukemia Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em 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