There are different types of treatment for childhood acute
lymphoblastic leukemia (ALL).
Different types of treatment are available for children with acute
(ALL). Some treatments are standard
(the currently used
treatment), and some are being tested in clinical
. A treatment clinical trial is a research study
help improve current treatments or obtain information on new treatments for
patients with cancer
. When clinical
trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
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.
Children with ALL should have their
treatment planned by a team of doctors with expertise in treating childhood
Treatment will be overseen by a
, a doctor who specializes
in treating children with cancer. The pediatric oncologist works with other pediatric
health professionals who are experts in treating children
and who specialize in certain areas of medicine
. These may
include the following specialists
exams are very important. Treatment can cause side effects
long after it has ended. These are called late effects
. Radiation therapy
to the brain may cause changes in mood, feelings, thinking, learning, or memory. Children younger than 4 years have a higher risk of side effects from radiation therapy to the brain.
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 PDQ
summary on Late Effects of Treatment for Childhood Cancer
The treatment of childhood ALL usually has three phases.
The treatment of childhood ALL is done in phases:
- Remission induction: This is the first phase of treatment. The goal is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.
- Consolidation/intensification: 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 relapse.
- Maintenance: 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 doses 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.
Four types of standard treatment are used:Chemotherapy
The way the chemotherapy is given depends on the child's risk group
. Children with high-risk ALL receive more anticancer drugs and higher doses of anticancer drugs than children with standard-risk ALL.
See Drugs Approved for Acute Lymphoblastic Leukemia for more information.
is a cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation
therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation
therapy uses a radioactive
substance sealed in needles, seeds
, wires, or catheters
that are placed directly into or near the cancer. External radiation therapy may be used to treat childhood ALL that has spread, or may spread, to the brain and spinal cord
Chemotherapy with stem cell transplant
Stem cell transplant
is a method of giving high doses of chemotherapy and sometimes total-body irradiation
, and then replacing the blood-forming cells destroyed by the cancer treatment. Stem cells
(immature blood cells) are removed from the blood or bone marrow of a donor
. After the patient receives treatment, the donor's stem cells are given to the patient through an infusion
. 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.
Stem cell transplant is rarely used as initial treatment for children and teenagers with ALL. It is used more often as part of treatment for ALL that relapses (comes back after treatment).
See Drugs Approved for Acute Lymphoblastic Leukemia for more information.
is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
New kinds of targeted therapies are also being studied in the treatment of childhood ALL.
See Drugs Approved for Acute Lymphoblastic Leukemia for more information.
Treatment is given to kill leukemia cells that have spread or may spread to the brain, spinal cord, or testicles.
Treatment to kill leukemia cells or prevent the spread of leukemia cells to the brain and spinal cord is called CNS-directed therapy. Chemotherapy may be used to treat
leukemia cells that have spread, or may spread, to the brain and spinal cord. Because standard chemotherapy may not reach leukemia cells in the CNS
(brain and spinal cord), 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.
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.
If the leukemia cells spread to the testicles
, treatment includes high doses of chemotherapy and sometimes radiation therapy.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI Web
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial
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 standard treatment
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.
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.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
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 recurring
(coming back) or reduce the side effects
of cancer treatment.
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 NCI's
listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose
the cancer or to find out the stage
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. This is sometimes called re-staging.
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 condition
has changed or if the cancer has recurred
(come back). These tests are sometimes called follow-up
tests or check-ups.
Treatment Options for Childhood Acute Lymphoblastic
Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (Standard Risk)
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with untreated childhood acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.
Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (High Risk)
Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (Special Groups)
T-cell childhood acute lymphoblastic leukemia
Infants with ALL
Treatments being studied in clinical trials
for infants with ALL include the following:
- A clinical trial of chemotherapy followed by a donor stem cell transplant for infants with certain gene changes.
Children 10 years and older and teenagers with ALL
Philadelphia chromosomeâ€“positive ALL
Relapsed Childhood Acute Lymphoblastic
Standard treatment of relapsed childhood acute lymphoblastic leukemia (ALL) that comes back outside the bone marrow may include the following:
Some of the treatments being studied in clinical trials
for relapsed childhood ALL include:
- New anticancer drugs and new combination chemotherapy treatments.
- Combination chemotherapy and new kinds of targeted therapies.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.
To Learn More About Childhood Acute Lymphoblastic Leukemia
- What You Need to Know Aboutâ„¢ Leukemia
- Computed Tomography (CT) Scans and Cancer
- Drugs Approved for Acute Lymphoblastic Leukemia
- Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation
- Targeted Cancer Therapies
For more childhood cancer
information and other general cancer resources, see the following:
- Childhood Cancers
- CureSearch for Children's Cancer
- Late Effects of Treatment for Childhood Cancer
- Adolescents and Young Adults with Cancer
- Young People with Cancer: A Handbook for Parents
- Cancer in Children and Adolescents
- Cancer Staging
- Coping with Cancer: Supportive and Palliative Care
- Questions to Ask Your Doctor About Cancer
- Cancer Library
- Information for Survivors/Caregivers/Advocates
Changes to This Summary (12/30/2014)
The PDQ cancer
information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Editorial changes were made to this summary.
About This PDQ Summary
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 Spanish.
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Purpose of This Summary
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.
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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.
Clinical Trial Information
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.
Clinical trials are listed in PDQ and can be found online at NCI's Web site. 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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National Cancer Institute: PDQÂ® Childhood Acute Lymphoblastic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/childALL/Patient. Accessed <MM/DD/YYYY>.
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