Consolidation treatments for acute lymphocytic leukemia
Consolidation, or intensification, treatment for acute lymphocytic leukemia (ALL) is given to prevent leukemia cells from coming back. The consolidation treatment phase begins when the person goes into remission after induction treatment. Consolidation treatment is needed because many people have minimal residual disease (MRD) after induction therapy. Consolidation treatment usually lasts a number of months.
Chemotherapy is the primary consolidation treatment for ALL. The chemotherapy is quite intense because the drugs are usually given in higher doses. The same drugs that were used for induction are often given for consolidation treatment. Other drugs may be added to the chemotherapy regimen.
The most common consolidation regimen for ALL includes:
- vincristine (Oncovin)
- daunorubicin (Cerubidine) or doxorubicin (Adriamycin)
- steroids such as prednisone or dexamethasone (Decadron, Dexasone)
Other drugs that may be added to the regimen include:
- cyclophosphamide (Cytoxan, Procytox)
- asparaginase (Kidrolase)
- etoposide (Vepesid, VP-16)
- high-dose methotrexate
- high-dose cytarabine (Cytosar, Ara-C)
- pegaspargase (Oncaspar)
Targeted therapy @(Model.HeadingTag)>
Targeted therapy is treatment that uses drugs or other substances to target specific molecules (usually proteins) involved in cancer cell growth while limiting harm to normal cells.
A targeted therapy drug called a tyrosine kinase inhibitor may be added to the chemotherapy regimen for people with leukemia cells that have the Philadelphia chromosome (called Ph+ ALL). The most common targeted therapy used to treat Ph+ ALL is imatinib (Gleevec).
Central nervous system prophylaxis @(Model.HeadingTag)>
The central nervous system (CNS) is the brain and spinal cord. Treatment given to prevent the leukemia cells from spreading to the CNS is called CNS prophylaxis. CNS prophylaxis is started with induction treatment and may continue during consolidation treatment with one or more of the following:
- chemotherapy given directly into the spinal fluid (called intrathecal chemotherapy) with methotrexate, cytarabine or a steroid such as prednisone
- high-dose methotrexate given intravenously
- radiation therapy to the brain
Stem cell transplant @(Model.HeadingTag)>
A stem cell transplant may be offered to people whose ALL goes into remission, but there is still a high risk it will relapse. There is a high risk of relapse with certain subtypes of ALL or other poor prognostic factors.
The preferred type of stem cell transplant is an allogeneic transplant if a matched donor is available. If a matched donor is not available, autologous stem cell transplant may be an option for some people.
Radiation therapy @(Model.HeadingTag)>
Radiation therapy may be given as part of the conditioning treatment before stem cell transplant. It may also be given to treat ALL that has spread to the central nervous system (CNS).
Supportive therapy @(Model.HeadingTag)>
Supportive therapy is important during every phase of ALL treatment. It is used to treat the complications that usually happen with treatments for ALL and the disease itself.
Supportive therapies given during consolidation treatment may include:
- antibiotics, antivirals or antifungals to prevent or fight infections
- growth factors to help the bone marrow recover from chemotherapy (chemotherapy can affect the bone marrow so it doesn’t make enough healthy blood cells, which can increase the risk for infection)
- transfusions of red blood cells, platelets, fresh frozen plasma and cryoprecipitate (a product that replaces clotting factors) as needed
American Cancer Society. Leukemia - Acute Lymphocytic (Adults). Atlanta, GA: American Cancer Society; 2013.
Goekbuget N, Hoelzer D . Diagnosis and Treatment of adult acute lymphoblastic leukemia. Wiernik PH, Goldman JM, Dutcher JP & Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 20: pp. 331-354.
Health Canada. Regulatory Decision Summary - Oncaspar. 2017: https://hpr-rps.hres.ca/reg-content/regulatory-decision-summary-detail.php?lang=en&linkID=RDS00219.
Kebriaei P, Champlin R, de Lima M, et al . Management of acute leukemias. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014: 131: pp. 1928-1954.
Kurtin SE . Leukemia and myelodysplastic syndromes. Yarbro, CH, Wujcki D, & Holmes Gobel B. (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 57: pp. 1369-1398.
National Cancer Institute. Adult Acute Lymphoblastic Leukemia Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.