All patients with Acute Lymphoblastic Leukemia (ALL), except those patients with a “Burkitt’s” translocation, initially receive combination chemotherapy with 3 or 4 drugs (Daunorubicin, Vincristine, Prednisone +/- L-asparaginase).
With these chemotherapy treatments, 75% of patients end up with no detectable leukemia in their bone marrow. This is referred to as a complete remission.
Chemotherapy is given directly into the patient's spinal canal, through a lumbar puncture or “spinal tap”, in order to treat (or prevent) leukemia in the central nervous system. Brain irradiation may be used for this purpose as well.
Adult patients with ALL who do not have high risk features and who are fit for treatment are treated for 9 months with multiple consolidation chemotherapy courses which are mostly given as an outpatient. Patients are then placed on maintenance chemotherapy pills for a further 18 months. This consolidation/maintenance chemotherapy is associated with a 40% cure rate for patients of 60 years or younger. However, this treatment is much less successful, and associated with more side effects in older patients.
Burkitt’s ALL patients are given chemotherapy combination which include cyclophosphamide and methotrexate, since these two agents are particularly effective in treating Burkitt’s disease. Further therapy may include chemotherapy with or without a BMT.
Blood and marrow transplant (BMT) is considered in first complete remission for ALL patients with features suggesting a less successful outcome with consolidation chemotherapy, or for those patients with ALL that recur after consolidation chemotherapy.