Acute Lymphoblastic Leukemia: Treatment & Medication
Acute Lymphoblastic Leukemia: Treatment & Medication
Medscape
Noriko Satake, MD, Clinical Fellow, Department of Pediatric Hematology-Oncology, Mattel Children's Hospital at University of California at Los Angeles
Kathleen Sakamoto, MD, Professor, Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine, Division of Hematology-Oncology and Pathology and Laboratory Medicine, University of California at Los Angeles
Updated: Jul 11, 2006
Medication
Drugs commonly used during remission induction therapy include dexamethasone or prednisone, vincristine, asparaginase, and daunorubicin. Consolidation therapy often includes MTX and 6-MP. Drugs used for intensification or continuation include cytarabine, cyclophosphamide, etoposide, dexamethasone, asparaginase, doxorubicin, MTX, 6-MP, and vincristine. Intrathecal chemotherapy includes MTX, hydrocortisone, and cytarabine.
Antineoplastics agents
Cancer chemotherapy is based on an understanding of tumor cell growth and how drugs affect this growth. After cells divide, they enter a period of growth (ie, phase G1), followed by DNA synthesis (ie, phase S). The next phase is a premitotic phase (ie, G2), then finally a mitotic cell division (ie, phase M).
Cell-division rates vary for different tumors. Most common cancers grow slowly compared with normal tissues, and the rate may be decreased in large tumors. This difference allows normal cells to recover from chemotherapy more quickly than malignant ones and is the rationale behind current cyclic dosage schedules.
Antineoplastic agents interfere with cell reproduction. Some agents are specific to phases of the cell cycle, whereas others (eg, alkylating agents, anthracyclines, cisplatin) are not. Cellular apoptosis (ie, programmed cell death) is another potential mechanism of many antineoplastic agents.
Prednisone (Deltasone)
Corticosteroid. Important chemotherapeutic agent in treatment of ALL. Used in induction and reinduction therapy. Also given as intermittent pulses during continuation therapy.
Dosing:
Adult
20-25 mg PO tid
Pediatric
40 mg/m2/d PO divided tid
Interactions:
May potentiate thrombogenic effects of asparaginase; barbiturates, phenytoin; rifampin may decrease effectiveness
Contraindications:
Documented hypersensitivity; serious infections (excluding meningitis and septic shock) and fungal infections; varicella infections
Precautions:
Pregnancy
B - Usually safe but benefits must outweigh the risks.
Precautions
Gradual tapering of dose required after prolonged treatment (ie, > 2 wk); toxicity includes fluid retention, hypertension, increased appetite, transient diabetes, acne, striae, personality changes, peptic ulcer, immunosuppression, osteoporosis, growth retardation; caution in diabetes, fungal infections, and osteonecrosis
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