Treatment of acute lymphoblastic leukemia

Induction of remission of acute lymphoblastic leukemia. Before starting treatment for the disease, anemia is corrected by blood transfusion, the risk of bleeding is minimized in case of platelet transfusions. Conduct rehabilitation of chronic foci of infection.

Additional hydration and administration of allopurinol (or urotoxicity, when the number of leukocytes is high and the risk is increased) is prescribed in order to protect the kidney tissue from the toxins that occur during tumor lysis syndrome. Remission implies the absence of blasts and the restoration of normal bone marrow functions. A 4-week course of combined chemotherapy is carried out; current induction is achieved in 95% of cases.

Intensification of acute lymphoblastic leukemia. Chemotherapy intensification courses are prescribed to achieve consolidation of remission. They improve the effectiveness of treatment, but at the expense of increased toxicity.

Cytotoxic drugs do not penetrate the central nervous system. Since the leukemic cells in this place can survive an effective systemic treatment, they use an additional treatment using the administration of drugs under the meninges to prevent recurrences in the CNS. Previously, treatment included the irradiation of the head area or the administration of high-dose methotrexate, but this therapy leads to adverse neuropsychic effects, so both methods are now excluded from the first-line treatment.

Continuing maintenance therapy for acute lymphoblastic leukemia. Low-intensity chemotherapy is continued for a relatively long period of time — up to 3 years after diagnosis. Cotrimoxazole is prescribed to prevent pneumonia caused by Pneumocystis jiroveci (carinii). Treatment of recurrent acute lymphoblastic leukemia. High-dose chemotherapy, often with total body irradiation and bone marrow transplantation, is used as an alternative to conventional chemotherapy after relapse.