Post-remission therapy for Philadelphia chromosome negative acute lymphoblastic leukemia in adults
- Richard A Larson, MD
Richard A Larson, MD
- Editor-in-Chief — Hematology
- Section Editor — Leukemia
- Professor of Medicine
- University of Chicago Pritzker School of Medicine
Over 80 percent of adult patients with newly diagnosed acute lymphoblastic leukemia (ALL) will attain a complete remission (CR) with intensive induction chemotherapy. However, without additional cytotoxic therapy, virtually all of these patients will relapse within a few weeks or months. In contrast, patients who receive post-remission therapy may expect five-year survival rates up to 60 percent in adults with standard risk disease.
Induction therapy aims to reduce the total body leukemia cell population from approximately 1012 to below the cytologically detectable level of about 109 cells. It is generally assumed, however, that a substantial burden of leukemia cells persists undetected in patients in initial clinical and morphologic CR (ie, "minimal residual disease"), leading to relapse within a few weeks or months if no further therapy were administered.
The primary aim of post-remission therapy (eg, consolidation, intensification) is to eradicate this minimal residual disease. There are three basic options for post-remission therapy (in order of increasing intensity): consolidation plus maintenance chemotherapy, autologous hematopoietic cell transplantation (HCT), or allogeneic HCT. The choice among these for an individual patient depends upon a number of factors, including:
●Expected rate of relapse with consolidation chemotherapy alone (influenced strongly by the patient and tumor characteristics)
●Expected morbidity and mortality associated with treatment options (as determined by patient characteristics such as age and comorbidities)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- RISK STRATIFICATION
- Identifying high risk disease
- Clinical features
- Older age
- CONSOLIDATION AND INTENSIFICATION
- Standard risk disease
- - Chemotherapy
- - Chemotherapy versus allogeneic transplant
- - Chemotherapy versus autologous transplant
- - Supportive care
- High risk disease
- - Allogeneic transplantation
- - Allogeneic transplant versus chemotherapy
- - Treatment of younger adults
- MAINTENANCE THERAPY
- FOLLOW UP
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS