Acute leukemia is the most common form of cancer in children, comprising approximately 30 percent of all childhood malignancies . Of the acute leukemias, acute lymphoblastic leukemia (ALL) occurs five times more commonly than acute myeloid leukemia (AML). Survival rates for ALL have improved dramatically during the since the 1980s, with a current five-year overall survival rates estimated at greater than 85 percent [1-4]. This improvement in survival is due to treatment of a large number of children on sequential standardized research protocols. Approximately 75 to 80 percent of children with newly diagnosed ALL participate in such trials, the goals of which are to improve clinical outcomes while minimizing acute toxicities and late-occurring adverse events.
The treatment of ALL in children is reviewed here. The epidemiology, presentation, classification, risk group stratification, and outcome of childhood ALL are discussed separately. (See "Overview of the presentation and diagnosis of acute lymphoblastic leukemia in children" and "Risk group stratification and prognosis for acute lymphoblastic leukemia in children and adolescents" and "Overview of the outcome of acute lymphoblastic leukemia in children and adolescents".)
Although the majority of children with ALL will be cured, consultation with palliative care specialists may be considered at the time of diagnosis as with any life threatening condition. (See "Pediatric palliative care".)
OVERVIEW OF TREATMENT
Successful treatment of children with ALL involves administration of a multidrug regimen that is divided into several phases (ie, induction, consolidation, and maintenance) and includes therapy directed to the central nervous system (CNS). Most treatment protocols take two to three years to complete, although the specific regimen varies depending upon immunophenotype and risk category (table 1). (See "Risk group stratification and prognosis for acute lymphoblastic leukemia in children and adolescents".)
At the time of diagnosis, patients with ALL commonly require transfusion support, treatment of suspected or proven infections with broad-spectrum antibiotics, and, for patients with a high tumor burden, correction of any metabolic imbalances such as hyperuricemia. A rare patient may require leukapheresis or exchange transfusion to control extreme leukocytosis. (See "Indications for red blood cell transfusion in infants and children" and "Uric acid renal diseases", section on 'Acute uric acid nephropathy'.)