What Is the First-Line Treatment for Acute Lymphoblastic Leukemia?
First-line treatment for acute lymphoblastic leukemia (ALL) follows a structured sequential approach, beginning with a preparatory phase and advancing to intensive induction. The primary clinical goal is to achieve complete remission as early, safely, and deeply as possible.
Treatment Goal
The aim of intensive induction therapy is to obtain a complete remission (CR) in as many patients and as early, safely, and deep as possible. CR rates in adults approximate 90%.
Treatment Approach
Treatment begins with a corticosteroid-based prephase, followed by an intensive multi-agent induction phase supported by comprehensive supportive care measures.
The complete protocol — specific agents, sequencing, and full supportive care detail — is available in the structured regimen below.
References
DOI: 10.1182/blood.2023023568
- For prephase, corticosteroids are usually administered for 5 to 7 days; other drugs are occasionally added, for example, cyclophosphamide (CP) and intrathecal (IT) prophylaxis after sampling of cerebrospinal fluid (CSF).
- First induction lasts ~4 weeks and carries the highest risk of complications, mandating for intensive support, including granulocyte colony stimulating factor (G-CSF), transfusions and optimal prophylaxis and management of infections.
- The induction backbone consists of vincristine, steroids, an anthracycline, and ASP.
- The aim of intensive induction therapy is to obtain a complete remission (CR) in as many patients and as early, safely, and deep as possible.
- CR rate in adults aged between 15 to 18 years and 55 to 65 years with Ph/BCR::ABL1-negative (Ph-) ALL is ~90%.
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