Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

36 Acute Lymphoblastic Leukemia

approaches and others receive therapy based upon their clinical

responsiveness.

■Allogeneic stem cell transplantation should be considered for

patients who either do not respond well or have a predictable poor

outcome based upon their biologic and clinical parameters (e.g.,

poor cytogenetic characteristics).

■Standard-Risk ALL with no adverse parameters:

■Induction: Multiple drug therapy including prednisone, vincristine,

L-asparaginase, cyclophosphamide, daunorubicin, filgastrim

■Consolidation: Cytarabine, 6-mercaptopurine, L-asparaginase, vin-

cristine, filgastrim

■CNS Therapy: Methotrexate (IT); number of doses and duration of

therapy depend on chosen protocol; need for CNS irradiation also

individualized

■Late intensification: Dexamethasone, vincristine, cyclophos-

phamide, then cyclophosphamide, cytarabine, and 6-thioguanine

■Maintenance: 6-Mercaptopurine; methotrexate; vincristine; pred-

nisone

■This therapeutic approach requires 2.5 to 3 years of therapy

■Mature B-Cell ALL (formerly called FAB type L3 or Burkitt’s Leukemia)

➣Cytoreductive phase: prednisone; cyclophosphamide

Course A: vincristine; ifosfamide; mesna; methotrexate;

leucovorin; dexamethasone; VM-26; cytosine arabinoside

Course B: vincristine; cyclophosphamide; methotrexate;

leucovorin; dexamethasone; Adriamycin

➣Intrathecal therapy is needed with the alternating cycles of inten-

sive therapy

➣All therapy for this form of ALL is completed in approximately

6 months

Side Effects & Complications

■Treatment Toxicities: Multiple chemotherapeutic agents are used in

the successful management of this disease; individual side effects

are too numerous to outline.

■Major considerations requiring attention are drug doses and inter-

actions, toxic effects on normal tissue (e.g., mucositis); modification

of doses based upon renal and liver function; constant surveillance

for infection and bleeding; and then drug-specific toxicities (e.g.,

L-asparaginase can deplete normal hemostatic factors; can cause

pancreatitis).

specific therapy

n/a