About Childhood Acute Lymphoblastic Leukemia

Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®)

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General Information About Childhood Acute Lymphoblastic Leukemia

Key Points:

Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which the bone marrow makes too many immature lymphocytes (a type of white blood cell).

Childhood acute lymphoblastic leukemia (also called ALL or acute lymphocytic leukemia) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated.

ALL is the most common type of cancer in children.

In a healthy child, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell.

A myeloid stem cell becomes one of three types of mature blood cells:

A lymphoid stem cell becomes a lymphoblast cell and then one of three types of lymphocytes (white blood cells):

Blood cell development; drawing shows the steps a blood stem cell goes through to become a red blood cell, platelet, or white blood cell. A myeloid stem cell becomes a red blood cell, a platelet, or a myeloblast, which then becomes a granulocyte (the types of granulocytes are eosinophils, basophils, and neutrophils). A lymphoid stem cell becomes a lymphoblast and then becomes a B-lymphocyte, T-lymphocyte, or natural killer cell.Blood cell development; drawing shows the steps a blood stem cell goes through to become a red blood cell, platelet, or white blood cell. A myeloid stem cell becomes a red blood cell, a platelet, or a myeloblast, which then becomes a granulocyte (the types of granulocytes are eosinophils, basophils, and neutrophils). A lymphoid stem cell becomes a lymphoblast and then becomes a B-lymphocyte, T-lymphocyte, or natural killer cell.

In a child with ALL, too many stem cells become lymphoblasts, B lymphocytes, or T lymphocytes. These cells are cancer (leukemia) cells. The leukemia cells do not work like normal lymphocytes and are not able to fight infection very well. Also, as the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, anemia, and easy bleeding.

This summary is about acute lymphoblastic leukemia in children, teenagers, and young adults. See the following PDQ summaries for information about other types of leukemia:

  • Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment
  • Adult Acute Lymphoblastic Leukemia Treatment
  • Chronic Lymphocytic Leukemia Treatment
  • Adult Acute Myeloid Leukemia Treatment
  • Chronic Myelogenous Leukemia Treatment
  • Hairy Cell Leukemia Treatment

Family history and being exposed to radiation may affect the risk of having childhood ALL.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child's doctor if you think your child may be at risk.

Possible risk factors for ALL include the following:

Signs of childhood ALL include fever and bruising.

These and other signs and symptoms may be caused by childhood ALL or by other conditions. Check with your child's doctor if your child has any of the following:

  • Fever.
  • Easy bruising or bleeding.
  • Petechiae (flat, pinpoint, dark-red spots under the skin caused by bleeding).
  • Bone or joint pain.
  • Painless lumps in the neck, underarm, stomach, or groin.
  • Pain or feeling of fullness below the ribs.
  • Weakness, feeling tired, or looking pale.
  • Loss of appetite.

Tests that examine the blood and bone marrow are used to detect (find) and diagnose childhood ALL.

The following tests and procedures may be used to diagnose childhood ALL and find out if leukemia cells have spread to other parts of the body such as the brain or testicles:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
  • Complete blood count (CBC) with differential: A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells and platelets.
    • The number and type of white blood cells.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the sample made up of red blood cells.

    Complete blood count (CBC); left panel shows blood being drawn from a vein on the inside of the elbow using a tube attached to a syringe; right panel shows a laboratory test tube with blood cells separated into layers: plasma, white blood cells, platelets, and red blood cells. Complete blood count (CBC); left panel shows blood being drawn from a vein on the inside of the elbow using a tube attached to a syringe; right panel shows a laboratory test tube with blood cells separated into layers: plasma, white blood cells, platelets, and red blood cells.

  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • Bone marrow aspiration and biopsy: The removal of bone marrow and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow and bone under a microscope to look for signs of cancer.

    Bone marrow aspiration and biopsy; drawing shows a patient lying face down on a table and a Jamshidi needle (a long, hollow needle) being inserted into the hip bone. Inset shows the Jamshidi needle being inserted through the skin into the bone marrow of the hip bone.Bone marrow aspiration and biopsy; drawing shows a patient lying face down on a table and a Jamshidi needle (a long, hollow needle) being inserted into the hip bone. Inset shows the Jamshidi needle being inserted through the skin into the bone marrow of the hip bone.

    The following tests may be done on the tissue that is removed:

    • Cytogenetic analysis: A laboratory test in which the cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes in the lymphocytes. For example, in Philadelphia chromosome–positive ALL, part of one chromosome is moved to another chromosome. This is called the “Philadelphia chromosome.” Other tests, such as fluorescence in situ hybridization (FISH), may also be done to look for certain changes in the chromosomes.

      Philadelphia chromosome; three-panel drawing shows a piece of chromosome 9 and a piece of chromosome 22 breaking off and trading places, creating a changed chromosome 22 called the Philadelphia chromosome. In the left panel, the drawing shows a normal chromosome 9 with the abl gene and a normal chromosome 22 with the bcr gene. In the center panel, the drawing shows chromosome 9 breaking apart in the abl gene and chromosome 22 breaking apart below the bcr gene. In the right panel, the drawing shows chromosome 9 with the piece from chromosome 22 attached and chromosome 22 with the piece from chromosome 9 containing part of the abl gene attached. The changed chromosome 22 with bcr-abl gene is called the Philadelphia chromosome.Philadelphia chromosome; three-panel drawing shows a piece of chromosome 9 and a piece of chromosome 22 breaking off and trading places, creating a changed chromosome 22 called the Philadelphia chromosome. In the left panel, the drawing shows a normal chromosome 9 with the abl gene and a normal chromosome 22 with the bcr gene. In the center panel, the drawing shows chromosome 9 breaking apart in the abl gene and chromosome 22 breaking apart below the bcr gene. In the right panel, the drawing shows chromosome 9 with the piece from chromosome 22 attached and chromosome 22 with the piece from chromosome 9 containing part of the abl gene attached. The changed chromosome 22 with bcr-abl gene is called the Philadelphia chromosome.

    • Immunophenotyping: A laboratory test in which the antigens or markers on the surface of a blood or bone marrow cell are checked to see if they are lymphocytes or myeloid cells. If the cells are malignant lymphocytes (cancer) they are checked to see if they are B lymphocytes or T lymphocytes.
  • Lumbar puncture: A procedure used to collect a sample of cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. The sample of fluid is checked for leukemia cells. This procedure is also called an LP or spinal tap.

    Lumbar puncture; drawing shows a patient lying in a curled position on a table and a spinal needle (a long, thin needle) being inserted into the lower back. Inset shows a close-up of the spinal needle inserted into the cerebrospinal fluid (CSF) in the lower part of the spinal column.Lumbar puncture; drawing shows a patient lying in a curled position on a table and a spinal needle (a long, thin needle) being inserted into the lower back. Inset shows a close-up of the spinal needle inserted into the cerebrospinal fluid (CSF) in the lower part of the spinal column.

    This procedure is done after leukemia is diagnosed to find out if leukemia cells have spread to the brain and spinal cord. Intrathecal chemotherapy is given after the sample of fluid is removed to treat any leukemia cells that may have spread to the brain and spinal cord.

  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. The chest x-ray is done to see if leukemia cells have formed a mass in the middle of the chest.
  • Testicular biopsy: The removal of cells or tissues from the testicles so they can be viewed under a microscope by a pathologist to check for signs of cancer. This procedure is done only if there seems to be anything unusual about the testicles during the physical exam.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on:

  • Age at diagnosis, gender, and race.
  • The number of white blood cells in the blood at diagnosis.
  • Whether the leukemia cells began from B lymphocytes or T lymphocytes.
  • Whether there are certain changes in the chromosomes or genes of the lymphocytes with cancer.
  • Whether the child has Down syndrome.
  • Whether leukemia cells are found in the cerebrospinal fluid.
  • How quickly and how low the leukemia cell count drops after initial treatment.

Treatment options depend on:

  • Whether the leukemia cells began from B lymphocytes or T lymphocytes.
  • Whether the child has standard-risk or high-risk ALL.
  • The age of the child at diagnosis.
  • Whether there are certain changes in the chromosomes of lymphocytes, such as the Philadelphia chromosome.
  • How quickly and how low the leukemia cell count drops after initial treatment.

For leukemia that relapses (comes back) after initial treatment, the prognosis and treatment options depend partly on the following:

  • How long it is between diagnosis and when the leukemia comes back after initial treatment.
  • Whether the leukemia comes back in the bone marrow or in other parts of the body.
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Risk Groups for Childhood Acute Lymphoblastic Leukemia

Key Points:

In childhood ALL, risk groups are used to plan treatment.

There are two risk groups in childhood ALL. They are described as:

  • Standard (low) risk: Includes children aged 1 to younger than 10 years who have a white blood cell count of less than 50,000/µL at diagnosis.
  • High risk: Includes children 10 years and older and/or children who have a white blood cell count of 50,000/µL or more at diagnosis.

Other factors that affect the risk group include the following:

It is important to know the risk group in order to plan treatment. Children with high-risk ALL usually receive more anticancer drugs and higher doses of anticancer drugs than children with standard-risk ALL.

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Relapsed Childhood Acute Lymphoblastic Leukemia

    Relapsed childhood ALL is cancer that has come back after it has been treated. The leukemia may come back in the blood and bone marrow, brain, spinal cord, testicles, or other parts of the body.

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    Treatment Option Overview

    Key Points:

    There are different types of treatment for childhood acute lymphoblastic leukemia (ALL).

    Different types of treatment are available for children with acute lymphoblastic leukemia (ALL). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

    Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

    Children with ALL should have their treatment planned by a team of doctors with expertise in treating childhood leukemia.

    Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with leukemia and who specialize in certain areas of medicine. These may include the following specialists:

    Regular follow-up exams are very important. Treatment can cause side effects long after it has ended. These are called late effects. Radiation therapy to the brain may cause changes in mood, feelings, thinking, learning, or memory. Children younger than 4 years have a higher risk of side effects from radiation therapy to the brain.

    Late effects of treatment for ALL also include the risk of second cancers (new types of cancer), especially brain tumors.

    Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. See the PDQ summary on Late Effects of Treatment for Childhood Cancer.

    The treatment of childhood ALL usually has three phases.

    The treatment of childhood ALL is done in phases:

    • Remission induction: This is the first phase of treatment. The goal is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.
    • Consolidation/intensification: This is the second phase of treatment. It begins once the leukemia is in remission. The goal of consolidation/intensification therapy is to kill any leukemia cells that remain in the body and may cause a relapse.
    • Maintenance: This is the third phase of treatment. The goal is to kill any remaining leukemia cells that may regrow and cause a relapse. Often the cancer treatments are given in lower doses than those used during the remission induction and consolidation/intensification phases. Not taking medication as ordered by the doctor during maintenance therapy increases the chance the cancer will come back. This is also called the continuation therapy phase.

    Four types of standard treatment are used:

    Chemotherapy

    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.

    The way the chemotherapy is given depends on the child's risk group. Children with high-risk ALL receive more anticancer drugs and higher doses of anticancer drugs than children with standard-risk ALL.

    See Drugs Approved for Acute Lymphoblastic Leukemia for more information.

    Radiation therapy

    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. External radiation therapy may be used to treat childhood ALL that has spread, or may spread, to the brain and spinal cord.

    Chemotherapy with stem cell transplant

    Stem cell transplant is a method of giving high doses of chemotherapy and sometimes total-body irradiation, and then replacing the blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of a donor. After the patient receives treatment, the donor's stem cells are given to the patient through an infusion. These reinfused stem cells grow into (and restore) the patient's blood cells. The stem cell donor doesn't have to be related to the patient.

    Stem cell transplant is rarely used as initial treatment for children and teenagers with ALL. It is used more often as part of treatment for ALL that relapses (comes back after treatment).

    See Drugs Approved for Acute Lymphoblastic Leukemia for more information.

    Stem Cell Transplant

    Drawing of stem cells being removed from a patient or donor. Blood is collected from a vein in the arm and flows through a machine that removes the stem cells; the remaining blood is returned to a vein in the other arm.Drawing of stem cells being removed from a patient or donor. Blood is collected from a vein in the arm and flows through a machine that removes the stem cells; the remaining blood is returned to a vein in the other arm.

    Drawing of a health care provider giving a patient treatment to kill blood-forming cells. Chemotherapy is given to the patient through a catheter in the chest.Drawing of a health care provider giving a patient treatment to kill blood-forming cells. Chemotherapy is given to the patient through a catheter in the chest.

    Drawing of stem cells being given to the patient through a catheter in the chest.Drawing of stem cells being given to the patient through a catheter in the chest.

    Stem cell transplant (Step 1). Blood is taken from a vein in the arm of the donor. The blood flows through a machine that removes the stem cells. Then the blood is returned to the donor through a vein in the other arm. Stem cell transplant (Step 2). The patient receives chemotherapy to kill blood-forming cells. The patient may receive radiation therapy (not shown). Stem cell transplant (Step 3). The patient receives stem cells through a catheter placed into a blood vessel in the chest.

    Targeted therapy

    Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

    Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs that block the enzyme, tyrosine kinase, which causes stem cells to become more white blood cells or blasts than the body needs. Imatinib mesylate (Gleevec) is a TKI used in the treatment of children with Philadelphia chromosome–positive ALL.

    New kinds of targeted therapies are also being studied in the treatment of childhood ALL.

    See Drugs Approved for Acute Lymphoblastic Leukemia for more information.

    Treatment is given to kill leukemia cells that have spread or may spread to the brain, spinal cord, or testicles.

    Treatment to kill leukemia cells or prevent the spread of leukemia cells to the brain and spinal cord is called CNS-directed therapy. Chemotherapy may be used to treat leukemia cells that have spread, or may spread, to the brain and spinal cord. Because standard chemotherapy may not reach leukemia cells in the CNS (brain and spinal cord), the cells are able to hide in the CNS. Systemic chemotherapy given in high doses or intrathecal chemotherapy (into the cerebrospinal fluid) is able to reach leukemia cells in the CNS. Sometimes external radiation therapy to the brain is also given.

    Intrathecal chemotherapy; drawing shows the cerebrospinal fluid (CSF) in the brain and spinal cord, and an Ommaya reservoir (a dome-shaped container that is placed under the scalp during surgery; it holds the drugs as they flow through a small tube into the brain). Top section shows a syringe and needle injecting anticancer drugs into the Ommaya reservoir. Bottom section shows a syringe and needle injecting anticancer drugs directly into the cerebrospinal fluid in the lower part of the spinal column.Intrathecal chemotherapy; drawing shows the cerebrospinal fluid (CSF) in the brain and spinal cord, and an Ommaya reservoir (a dome-shaped container that is placed under the scalp during surgery; it holds the drugs as they flow through a small tube into the brain). Top section shows a syringe and needle injecting anticancer drugs into the Ommaya reservoir. Bottom section shows a syringe and needle injecting anticancer drugs directly into the cerebrospinal fluid in the lower part of the spinal column.

    These treatments are given in addition to treatment that is used to kill leukemia cells in the rest of the body. All children with ALL receive CNS-directed therapy as part of induction therapy and consolidation/intensification therapy and sometimes during maintenance therapy.

    If the leukemia cells spread to the testicles, treatment includes high doses of chemotherapy and sometimes radiation therapy.

    New types of treatment are being tested in clinical trials.

    Information about clinical trials is available from the NCI Web site.

    Patients may want to think about taking part in a clinical trial.

    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

    Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

    Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

    Patients can enter clinical trials before, during, or after starting their cancer treatment.

    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

    Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

    Follow-up tests may be needed.

    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

    Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

    Bone marrow aspiration and biopsy is done during all phases of treatment to see how well the treatment is working.

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    Treatment Options for Childhood Acute Lymphoblastic Leukemia

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      Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (Standard Risk)

        The treatment of standard-risk childhood acute lymphoblastic leukemia (ALL) during the remission induction, consolidation/intensification, and maintenance phases always includes combination chemotherapy. Children who are not in remission after having combination chemotherapy during the induction phase may be helped by more chemotherapy. When they are in remission, a stem cell transplant using stem cells from a donor may be done.

        Intrathecal chemotherapy is given to prevent the spread of leukemiacells to the brain and spinal cord.

        Treatments being studied in clinical trials for standard-risk ALL include new chemotherapy regimens.

        Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with untreated childhood acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.

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        Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (High Risk)

          The treatment of high-risk childhood acute lymphoblastic leukemia (ALL) during the remission induction, consolidation/intensification, and maintenance phases always includes combination chemotherapy. Children in the high-risk ALL group are given more anticancer drugs and higher doses of anticancer drugs, especially during the consolidation/intensification phase, than children in the standard-risk group.

          Intrathecal and systemic chemotherapy are given to prevent the spread of leukemiacells to the brain and spinal cord. Sometimes radiation therapy to the brain is also given.

          Treatments being studied in clinical trials for high-risk ALL include new chemotherapyregimens and stem cell transplant.

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          Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (Special Groups)

            T-cell childhood acute lymphoblastic leukemia

            The treatment of T-cell childhood acute lymphoblastic leukemia (ALL) during the remission induction, consolidation/intensification, and maintenance phases always includes combination chemotherapy. Children with T-cell ALL are given more anticancer drugs and higher doses of anticancer drugs than children with B-cell ALL in the standard-risk group.

            Intrathecal and systemic chemotherapy are given to prevent the spread of leukemiacells to the brain and spinal cord. Sometimes radiation therapy to the brain is also given.

            Treatments being studied in clinical trials for T-cell ALL include new anticancer agents and chemotherapyregimens.

            Infants with ALL

            The treatment of infants with ALL during the remission induction, consolidation/intensification, and maintenance phases always includes combination chemotherapy. Infants with ALL are given different anticancer drugs and higher doses of anticancer drugs than children 1 year and older in the standard-risk group. It is not clear whether a stem cell transplant during first remission improves survival.

            Intrathecal and systemic chemotherapy are given to prevent the spread of leukemiacells to the brain and spinal cord.

            Treatments being studied in clinical trials for infants with ALL include the following:

            Children 10 years and older and teenagers with ALL

            The treatment of ALL in children and teenagers (10 years and older) during the remission induction, consolidation/intensification, and maintenance phases always includes combination chemotherapy. Children 10 years and older and teenagers with ALL are given more anticancer drugs and higher doses of anticancer drugs than children in the standard-risk group.

            Intrathecal and systemic chemotherapy are given to prevent the spread of leukemiacells to the brain and spinal cord. Sometimes radiation therapy to the brain is also given.

            Treatments being studied in clinical trials for children 10 years and older and teenagers with ALL include new anticancer agents and chemotherapyregimens.

            Philadelphia chromosome–positive ALL

            The treatment of Philadelphia chromosome–positive childhood ALL during the remission induction, consolidation/intensification, and maintenance phases may include the following:

            Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with T-cell childhood acute lymphoblastic leukemia and Philadelphia chromosome positive childhood precursor acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.

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            Relapsed Childhood Acute Lymphoblastic Leukemia

              Standard treatment of relapsed childhood acute lymphoblastic leukemia (ALL) that comes back in the bone marrow may include the following:

              Standard treatment of relapsed childhood acute lymphoblastic leukemia (ALL) that comes back outside the bone marrow may include the following:

              Some of the treatments being studied in clinical trials for relapsed childhood ALL include:

              • New anticancer drugs and new combination chemotherapy treatments.
              • Combination chemotherapy and new kinds of targeted therapies.

              Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.

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              To Learn More About Childhood Acute Lymphoblastic Leukemia

                For more information from the National Cancer Institute about childhood acute lymphoblastic leukemia, see the following:

                For more childhood cancer information and other general cancer resources, see the following:

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                Changes to This Summary (11/14/2013)

                  The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

                  Changes were made to this summary to match those made to the health professional version.

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                  About This PDQ Summary

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                    Purpose of This Summary

                      This PDQ cancer information summary has current information about the treatment of childhood acute lymphoblastic leukemia. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

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                      Reviewers and Updates

                        Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.

                        The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

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                        Clinical Trial Information

                          A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

                          Clinical trials are listed in PDQ and can be found online at NCI's Web site. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

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                            National Cancer Institute: PDQ® Childhood Acute Lymphoblastic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/childALL/Patient. Accessed <MM/DD/YYYY>.

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