Acute lymphoblastic leukaemia (ALL)

Overview:

• Predominantly a disease of children
• Is potentially curable
• 90% of children respond to treatment and 50-60% are cured
• The cure rate in adults is only about 30%

Treatment:

• The principles of initial treatment are the same as those for AML
• Cyclical chemotherapy comprising:
• Vincristine
• Prednisolone
• L-asparaginase
• Doxorubicin

• The sequence of treatment, however, is different to AML because ALL has a propensity for involvement of the CNS, thus treatment includes prophylactic intrathecal drugs (e.g. methotrexate)
• Most patients receive oral maintenance therapy for 2-3 years

Treatment at recurrence:

• A proportion of patients are cured with the initial therapy
• In the rest, the disease recurs and ultimately proves fatal unless a second remission can be achieved (high-dose treatment and some form of transplant procedure)
• With such treatment, a further 20-30% of patients will survive long-term