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Treatment of Acute Lymphoblastic Leukemia

General

The principle for treating acute lymphoblastic leukemia is to give chemotherapy which reduces or optimally, eradicates the leukemic clone.

About half of the patients fall into an age group where chemotherapy is expected to be beneficial or eradicate the disease. The patient's age is an indicator for what is reasonable to expect. The condition for achieving long-term survival or curing the disease is to reach complete hematological remission (CHR), which is defined as < 5% blasts in normocellular bone marrow combined with a nearly normalized cell count in the blood.  

In practice, this is only achievable after infusion of chemotherapy with such a high dose intensity that the treatment is life-threatening. Chemotherapy will heavily affect normal hematopoiesis causing bone marrow aplasia with serious neutropenia, thrombocytopenia, and anemia, in periods from one to multiple weeks.

The most intensive treatment regimens are relevant for patients under about 60 years, while patients between 60-70 years can be treated with an intensive induction protocol to cure the disease only in certain cases. Patients older than 70 years will in most cases, achieve the best benefit from good palliative treatment. An exception is patients with acute hypergranular promyelocyte leukemia (M3).

Diagnostics and treatment to cure the disease should occur at a hematology section of a regional hospital or a well-equipped central hospital with a designated section for blood diseases. They should have sufficient resources of blood banking and competent on-call personnel. If necessary, there should be cooperation with a regional hospital.

Indication

  • Acute lymphoblastic leukemia 

Goals

  • Hematological, cytogenetic, and molecular control of the disease.
  • Cure the disease. 

Norsk selskap for hematologi. Handlingsprogram for diagnostikk og behandling av akutt lymfoblastisk leukemi/lymfoblastisk lymfom og burkitt lymfom leukemi hos voksne [Online]. Mars 2006 [hentet 15. april 2007]; tilgjengelig fra: URL:http://www.legeforeningen.no/asset/33493/1/33493_1.doc

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