Acute Lymphocytic Leukemia - Highlights

Highlights

Drug Approvals

• Imatinib (Gleevec) is approved for treating Philadelphia chromosome-positive acute lymphocytic leukemia (ALL) that has not responded to treatment, or has returned after treatment.
• Dasatinib (Sprycel) is approved for patients with Philadelphia chromosome-positive ALL who are resistant to imatinib. An important 2006 New England Journal of Medicine study indicated dasatinib’s benefit in treating these patients.
• Pegaspargase (Oncaspar) is approved for treating children and adults with newly diagnosed ALL. This drug was previously approved only for patients who were allergic to L-asparaginase (Elspar). Patients can now receive pegaspargase instead of L-asparaginase as part of a combination chemotherapy regimen. With pegaspargase, patients need only 3 injections during a 20-week treatment, instead of the 21 injections required for L-asparaginase.

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Investigational Drugs

Nilotinib (AMN-107), a drug that is similar to dasatinib, has shown promising results in treating patients with Philadelphia chromosome-positive ALL who are resistant to imatinib.

Treatment Research

• The chemotherapy drug 6-mercaptopurine (Purinethol) should remain a standard part of maintenance therapy for children with ALL, recommends a 2006 study in the Lancet. Researchers found that an alternative drug, 6-thioguanine (Tabloid), has risky side effects that outweigh its benefits.
• Allogeneic (donor) stem cell transplantation may be an effective treatment option for patients with Philadelphia chromosome-positive ALL who are resistant to imatinib, suggests a 2006 study in Blood.

Cranial Radiation and Stroke Risk

Children with leukemia who receive cranial (skull) radiation therapy may be at increased risk for stroke decades after their treatment ends, suggests a 2006 study in the Journal of Clinical Oncology. Researchers found that strokes could happen 10 - 20 years after treatment. Stroke occurred on average in 1 in 125 patients with leukemia compared to 1 in 500 healthy patients. Patients who received the highest doses of radiation had the greatest risk of stroke.

Review Date: 01/16/2007
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital