begins or within the first month of treatment. It can be used to draw blood for testing purposes and to administer medication, chemotherapy, blood products, and certain types of nutrition. The VAD may remain in your child for the duration of treatment and will be removed when it is no longer needed. There are different types of VADs, such as a port inserted under the skin or a Broviac/Hickman that has a tube, or lumen, which comes out of your child’s chest. Your healthcare team will discuss each type with you and help you choose the best device for your child’s treatment. You will be taught how to care for this device at home. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from growing. Multiple chemotherapy drugs are used to treat both types of ALL (B-cell or T-cell ALL). These medicines are given by mouth; into a vein or VAD, such as a port or Broviac/Hickman (IV); by injection into a muscle (IM); or by a spinal tap into the spinal fluid (called intrathecal, or IT). These drugs are used in combination and in a specific sequence called phases of treatment. Each phase may use different medications and have different schedules for visiting the hospital or clinic. Your healthcare team will discuss the medicines used during each phase and their side effects. INDUCTION The first phase of treatment is called induction. Most children will begin this phase of treatment in the hospital at the time of diagnosis and, depending on their condition, some of this therapy may be given in an outpatient clinic. The goal of the first phase of treatment is to kill all of the leukemia cells and allow normal blood cells to grow again. This is called remission . It is important to remember that in remission, signs and symptoms of the cancer have disappeared but leukemia cells may still be hiding in the body. A bone marrow aspirate and a special blood test called minimal residual disease (MRD) will be performed at certain times during the induction phase to determine how quickly your child is responding to treatment. The goal is to have fewer than 5% leukemia cells or “blasts” in the bone marrow by the 8th day of the induction treatment. A bone marrow aspirate and MRD also will be performed at the end of the induction phase to determine if your child is in remission. Most children with ALL will achieve remission by the end of the induction phase; however, if the bone marrow or MRD does not show that remission has happened after induction, your healthcare team will discuss with you further chemotherapy treatments to achieve remission. Even though most children achieve a remission by the end of the induction phase, studies confirm that if treatment was stopped after induction, the leukemia cells would return. As a result, therapy continues for 2–3 years after diagnosis. CONSOLIDATION/INTENSIFICATION The middle phases of treatment, called consolidation/intensification, begin after remission has been achieved. The goals of these phases of treatment are to kill any remaining leukemia cells and to prevent a relapse (i.e., the leukemia cells come back). The intensity of this phase varies considerably based on the risk group in which your child is treated. This phase of therapy may last 6–9 months. MAINTENANCE The final phase of treatment is called maintenance. This phase continues until there has been 2–3 years of continued remission, depending on the protocol used. Boys receive chemotherapy longer than girls because the
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