How To Make An Appointment | Call the
Department of
Pediatrics at
212-639-5954 | |
|
|
More about Treatment
In the United States, most children with ALL are treated with protocols developed by the Children's Cancer Group (CCG) or the Pediatric Oncology Group (POG). Recently, these two groups have joined together to form the Children's Oncology Group (COG). Future treatment protocols will come through COG.
Children with ALL often have low blood counts and may need blood transfusions to relieve symptoms as well as antibiotics to treat infections.
- The first step in treatment for ALL is remission induction, which is aimed at achieving a state in which there is no visible evidence of disease and blood counts are normal. Hospitalization may be required for this step. A common treatment approach is a four-week course of weekly vincristine and prednisone along with L-asparaginase. Doxorubicin, daunorubicin, or cyclophosphamide may be added for patients at high risk. Patients at standard risk or low risk may only need three chemotherapy drugs. Other drugs maybe given for supportive care. For example, allopurinol may be given to reduce the uric acid that may form and trimethoprim/sulfa may be given to try to prevent Pneumocystis pneumonia.
- Treatment targeting the central nervous system (CNS) -- the brain and spinal cord -- is usually given during the remission induction phase and during the first three treatment sessions, when remission is well established. The drug methotrexate is usually given intrathecally, which is by means of an injection into the cerebrospinal fluid, the liquid that bathes the central nervous system. The procedure to do this, a lumbar puncture, is repeated up to 18 times during the early and later phases of treatment. Cytarabine, hydrocortisone, or both may be added to methotrexate. Radiation therapy to the head is necessary if the disease is present in the CNS. Radiation may be used to prevent the disease from spreading there in patients at very high risk. In such cases, the treatment is called prophylactic, which means preventive.
- Continuation therapy or maintenance therapy generally lasts two to three years after cancer remission is attained. For patients at low-risk, this treatment is less intensive than remission induction. A common treatment approach is intermittent methotrexate and daily 6-mercaptopurine with monthly vincristine and prednisone.
- About one-quarter of children with ALL will experience a cancer relapse, but most will respond to reinduction therapy. Bone marrow transplantation should be considered after a second remission is achieved, especially in patients whose cancer relapse occurs less than 36 months after diagnosis.
Remission Induction Side Effects
Side effects during remission induction can be significant, and patients usually remain in the hospital for a period of three to six weeks. Treatment for ALL is aimed at the leukemic blood cells, but normal blood cells are also affected. All patients will have lowered blood counts that lead to a variety of symptoms. Low white blood cell counts put patients at increased risk of infection. Treatment with antibiotics to prevent or treat infections is a likely measure oncologists will take. In some situations, your child will be in isolation, and visitors to his or her room may need to wear gowns, masks, and gloves as preventive measures.
Low white blood cell counts generally also lead to inflammation of the mucous membranes in the mouth and gastrointestinal tract. This is called mucositis. The tissues become very dry and may crack or bleed. Specific oral care regimens help minimize discomfort and prevent secondary infections. Mouth sores can make eating painful. The mouth sores themselves can cause pain that requires pain medication. Nausea, vomiting, and diarrhea are side effects for which effective treatments exist.
Hair may fall out, and this is can be an especially upsetting side effect. Wigs and scarves may help minimize the distress hair loss causes. Low platelet counts lead to easy bruising and bleeding. Taking care to prevent injuries is very important. Low red blood cell counts cause anemia and make patients feel tired and weak. Sometimes patients are short of breath or may experience a fast heartbeat rate. Blood transfusions will be necessary to replace red blood cells and platelets.
Many patients are given stimulating factors called G-CSF or GM-CSF. These stimulate the development of new white blood cells so that cell counts are low for a shorter period of time. The initial treatment and the severity of side effects can be very difficult and wearing on a patient. While blood counts are low, your child may find it difficult to carry on normal activities. Simple exercise, such as walking, may seem overwhelming.
Your doctors and nurses will do everything in their power to minimize the discomfort, sadness, and boredom that are common during this initial phase of treatment. Social workers, psychiatrists, and psychologists can help you and your child with depression and the ups and downs commonly experienced during treatment. Social workers can also help with financial issues related to treatment. Finally, all hospitals have clergy who are available to speak to you and provide spiritual support and guidance.
Resuming Activities
After the initial hospitalization period, your child will slowly begin to resume normal activities, but work and school may have to be postponed. Strength and stamina will return gradually. The doctors and nurses will provide more specific guidelines on what to expect based on individual treatment regimens and each individual patient's responses.
