Acute Lymphocytic Leukemia Archive Questions

Below are Dr. Gojo’s answers to Acute Lymphocytic Leukemia questions
received through the Ask the Expert feature.

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Now displaying records 1 to 2 of 2.

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Q : 1 07/31/2009

If a patient (32 years old) is receiving maintenance care after completing chemotherapy and radiation treatment and then has a relapse of ALL, should they begin treatment again? In the maintenance stage, is stopping Vincristine and giving Vinblastine the correct thing to do? Yes, if ALL relapses we recommend reinduction chemotherapy particularly in patients of younger age.

Q : 2 11/12/2008

In your opinion, what is the "standard of care" for a patient with relapsed (after three years) adult lymphoblastic lymphoma (T-cell) (when the initial treatment was hyper-CVAD with 2 years of maintenance methotraxate, 6-MP, dexamthasone, and vincristine)? I do not think that there is standard of care. Depending on the age, cytogenetics, and performance status, we usually treat patient with re-induction chemo to achieve CR followed by allogeneic transplant. The options are: similar regimens used in the therapy of lymphoblastic lymphoma such as Larson/CALGB regimen, BFM type of regimen (both include some agents that are not given with hyperCVAD), or other regimens or clinical study or repeating HyperCVAD. BUT, the goal is to get the patient into remission to move ahead with alloBMT. I think that the most important determinants which regimen to choose are whether the patient can tolerate agressive chemo or not, whether the pt is a candidate for alloBMT. Any of proposed regimens should be fine if the answer is positive. I think that the physician who provided the initial therapy should be able to discuss these details with you.

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