Refractory and Relapsed Childhood ALL

Most children with ALL are cured with standard chemotherapy treatments. But about 15 percent of young patients have ALL that returns after remission. This is referred to as a “relapse” of the disease (or “relapsed ALL”). Some children are unable to achieve a remission because their cancer does not respond to treatment. In these cases, the disease is referred to as “refractory” (or “refractory ALL”).

Relapsed/refractory disease is very serious and can be more difficult to treat. But there are treatment options available. Treatment for relapsed or refractory ALL is usually more intensive than the treatment used following initial diagnosis. It is important to understand all your child’s treatment options.

Before treatment, genetic testing of the leukemia cells is recommended for patients with relapsed or refractory disease. The mutational pattern of the leukemia cells may be different from when the disease was first diagnosed, and this can affect treatment decisions.

For patients with Ph+ ALL, new mutations in the BCR-ABL1 gene may occur over time. Some mutations can lead to resistance to certain TKIs. Before a patient starts treatment, BCR-ABL1 mutation testing should be done to look for new mutations that may cause certain TKIs to stop working.

Treatment Options for Relapsed and Refractory ALL 

Treatments for relapsed/ refractory ALL may include:

  • A clinical trial
  • New or different chemotherapy drugs or new combinations of chemotherapy drugs
  • For patients with Ph+ All, chemotherapy with a different TKI than the one used during initial therapy
  • Blinatumomab (Blincyto®) for patients with B-cell ALL
  • Inotuzumab ozogamicin (Besponsa®) for patients with B-cell ALL
  • Nelarabine-containing regimen for patients with T-cell ALL
  • Bortezomib-containing regimen for patients with T-cell ALL
  • Allogeneic stem cell transplantation for patients with an available donor
  • CAR T-cell therapy for patients with B-cell ALL

For information about the drugs listed on this page, visit Drug Listings.

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