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Adult Acute Lymphoblastic Leukemia Treatment (Professional) (cont.)

Stage Information for Adult ALL

There is no clear-cut staging system for this disease. This disease is classified as untreated, in remission, or recurrent.

Untreated Adult ALL

For a newly diagnosed patient with no prior treatment, untreated adult ALL is defined by the following:

  • Abnormal white blood cell count and differential.
  • Abnormal hematocrit/hemoglobin and platelet counts.
  • Abnormal bone marrow with more than 5% blasts.
  • Signs and symptoms of the disease.

Adult ALL in Remission

A patient who has received remission-induction treatment of ALL is in remission if all of the following criteria are met:

  • Bone marrow is normocellular with no more than 5% blasts.
  • There are no signs or symptoms of the disease.
  • There are no signs or symptoms of central nervous system leukemia or other extramedullary infiltration.
  • All of the following laboratory values are within normal limits:
    • White blood cell count and differential.
    • Hematocrit/hemoglobin level.
    • Platelet count.

Treatment Option Overview

Successful treatment of ALL consists of the control of bone marrow and systemic disease and the treatment (or prevention) of sanctuary-site disease, particularly the central nervous system (CNS).[1,2] The cornerstone of this strategy includes systemically administered combination chemotherapy with CNS preventive therapy. CNS prophylaxis is achieved with chemotherapy (intrathecal and/or high-dose systemic therapy) and, in some cases, cranial radiation therapy.

Treatment is divided into the following three phases:

  • Remission induction.
  • CNS prophylaxis.
  • Postremission (also called remission continuation or maintenance).

The average length of treatment for ALL varies between 1.5 and 3 years in the effort to eradicate the leukemic cell population. Younger adults with ALL may be eligible for selected clinical trials for childhood ALL. (Refer to the PDQ summary on Childhood Acute Lymphoblastic Leukemia Treatment for more information.)

Entry into a clinical trial is highly desirable to assure adequate patient treatment and maximal information retrieval from the treatment of this highly responsive, but usually fatal, disease.

Table 2. Standard Treatment Options for Adult ALL

CNS = central nervous system.
Disease StatusStandard Treatment Options
Untreated ALLRemission induction therapy
CNS prophylaxis therapy
ALL in remissionPostremission therapy
CNS prophylaxis therapy
Recurrent ALLReinduction chemotherapy
Palliative radiation therapy
Dasatinib

References:

  1. Clarkson BD, Gee T, Arlin ZA, et al.: Current status of treatment of acute leukemia in adults: an overview of the Memorial experience and review of literature. Crit Rev Oncol Hematol 4 (3): 221-48, 1986.
  2. Hoelzer D, Gale RP: Acute lymphoblastic leukemia in adults: recent progress, future directions. Semin Hematol 24 (1): 27-39, 1987.
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