Although standard chemotherapy regimens used in the treatment of childhood acute lymphoblastic leukemia (ALL) vary according to the disease risk group (standard, intermediate, high risk) and treatment protocol, the following drug groups are generally used:
🧪 Phase 1: Induction (Remission Induction)
Purpose: To destroy most of the leukemic cells and achieve complete remission (less than 5% blasts in the bone marrow). Common drugs:
- Prednisone or Dexamethasone (glucocorticoids): induce apoptosis in lymphoblasts.
- Vincristine (vinca alkaloid): disrupts mitosis.
- L-Asparaginase or PEG-Asparaginase: depletes asparagine, starving leukemic cells.
- Daunorubicin (in high-risk patients): anthracycline that damages DNA.
- Intrathecal Methotrexate: CNS prophylaxis (injected into cerebrospinal fluid).
💉 Phase 2: Consolidation (Intensification/Pegging Therapy)
Purpose: To eliminate any residual disease (minimal residual disease – MRD) and prevent resistance. Commonly used drugs are:
- 6-Mercaptopurine (6-MP): purine analog, interferes with DNA/RNA synthesis.
- High-dose Methotrexate (IV or intrathecal): antimetabolite, inhibits dihydrofolate reductase.
- Cytarabine (Ara-C): pyrimidine analog, inhibits DNA polymerase.
- Vincristine (again): to reinforce antimitotic effect.
- Continued intrathecal therapy for CNS protection.
🧠 Phase 3: Reinduction (Delayed Intensification / Reconsolidation)
Purpose: To eliminate any remaining resistant leukemic cells and deepen remission. Common drugs (often similar to Induction) are:
- Dexamethasone or Prednisone
- Vincristine
- L-Asparaginase
- Daunorubicin
- Cyclophosphamide (sometimes added)
- Cytarabine and Thioguanine in some variants
- Intrathecal chemotherapy continues
🧬 Phase 4: Maintenance (Continuation Therapy)
Purpose: To maintain remission and prevent relapse over a prolonged period. Common drugs are as follows:
- 6-Mercaptopurine (daily, oral)
- Methotrexate (weekly, oral or injection)
- Vincristine and Dexamethasone (given monthly in pulses)
- Periodic intrathecal therapy continues
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