Treatment of Childhood Acute Nonlymphoblastic Leukemia: A Review

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Abstract
Recommendations for the treatment of ANLL in general, and in pediatrics more specifically, are still conflicting. Overall, a child diagnosed with ANLL has a 35-50% of remaining alive long term, without disease. Induction chemotherapy with cytarabine and daunorubicin will achieve remission in about 80% of children with ANLL. So far, intensifying induction chemotherapy by adding more agents has not changed this result significantly. Major changes in induction chemotherapy may come from either new chemotherapeutic agents or biological agents that hasten bone marrow recovery after treatment. Such an approach might allow more dose-intensive drug administration without increased toxicity. Another question that is slowly being answered with the ongoing trials is the one concerning maintenance. So far, all the pediatric trials that have tried to shorten the maintenance therapy of this disease were able to do so without jeopardizing the final outcome. The final optimal minimal duration of therapy has yet to be established. The best therapy for a patient who has achieved a remission is still the most difficult question regarding the treatment of this disease. So far, allogeneic BMT has yielded the best results, with a disease-free interval varying between 55 and 65%. However, one-third of these patients have chronic GvHD and, therefore, a somewhat diminished quality of life. As preparative regimens and marrow purging protocols evolve, the results of autologous bone marrow transplantation seem to be improving, with disease-free intervals of 35-50% reported.