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 coming 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. The goal of maintenance is to keep the leukemia in remission. Maintenance is much less intensive than previous phases and consists of oral medicines given at home every day. Intermittent IV and IT (into the cerebral spinal fluid) medications are given in the clinic. Most children may return to school during this phase of treatment. Children begin to feel better and their hair starts to grow back. RADIATION THERAPY Radiation treatment is very precise and is given in strictly measured amounts by radiation therapy experts. If radiation is necessary for your child, the radiation oncologist will discuss with you exactly how the radiation will be given and how long the treatments will last. You may also choose to read the Radiation Therapy Handbook for Patients and Families that is available on the APHON website. BONE MARROW TRANSPLANT (BMT) A bone marrow transplant (BMT), also known as stem cell transplant, may be one of the treatment options offered to your family if there is a relapse or it may be part of the treatment plan if your child has high- or very high-risk ALL. The purpose of a BMT is to destroy the relapsed leukemia cells and replace them with normal blood cells. Your child will first receive very high doses of chemotherapy and sometimes radiation therapy to the whole body to destroy all of the blood cells (both the healthy cells and the leukemia cells). Then new bone marrow will be infused, much like a blood transfusion. The new bone marrow may come from different sources and must be a good match for your child. The donor may be related to the child, such as a brother or sister (called a matched family donor), or the donor may be someone who is not related to the child (an unrelated donor). Many children’s cancer hospitals are using umbilical cord blood cells or peripheral blood stem cells as a cell source. BMT can be a difficult process to go through for a child and family. There may be side effects from the chemotherapy, radiation, or medicine used to help the child during and after transplant. Your BMT team will discuss the side effects and risks associated with BMT with you in detail.
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL THERAPY
Chimeric antigen receptor T-cell (CAR-T) therapy may be one of the treatment options offered to your family if there is a relapse or it may be part of the treatment plan if your child has high- or very high-risk ALL. CAR-T therapy uses your child’s T-cells (a type of white blood cell) by altering them in a lab to find and destroy leukemia cells. First, your child’s T-cells are removed from their blood using a procedure called leukapheresis. Next, the T-cells are sent to a lab and a specific chimeric antigen receptor (CAR) is added which will look for your child’s leukemia cells. Once the CAR T-cells are ready, your child may receive chemotherapy for a few days to weaken their immune system and give the CAR T-cells a better chance to find and attack the leukemia cells. Then, the CAR T-cells will be infused, much like a blood tranfusion. Your team will discuss the side effects and risks associated with CAR-T therapy with you in detail.
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