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Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow. The overall cure rate for ALL in children is about 90% in the United States. But in some cases, it does not go away or comes back after treatment.
Relapsed acute lymphoblastic leukemia is ALL that comes back after treatment. This is called a relapse or recurrence. It can happen months or years later.
Refractory acute lymphoblastic leukemia is ALL that does not respond to treatment and does not go away despite treatment.
Relapsed or refractory leukemia happens in 15–20% of childhood ALL patients in the United States.
Treatment for relapsed or refractory leukemia is often more intensive than for newly diagnosed ALL. Treatment may include:
For some patients, treatment may be offered as part of a clinical trial.
Signs and symptoms of relapsed or refractory ALL include:
Relapsed or refractory childhood ALL can be a challenge to treat. Treatment may include chemotherapy, radiation therapy, stem cell (bone marrow) transplant, immunotherapy, targeted therapy, or a combination of treatments. A clinical trial may be an option.
Patients with relapsed or refractory ALL may need high doses of chemotherapy.
Medicines may include:
Patients with T-cell ALL may receive nelarabine or bortezomib.
Other treatment options include:
The treatment plan will be based on several factors. Doctors consider:
Your child’s treatment plan may be different depending on where leukemia cells are found, such as the bone marrow, spinal fluid, or testicles.
ALL that returns more than 6 months after the end of treatment has a better treatment outlook than ALL that comes back sooner.
The care team may also look at treatment response and minimal residual disease (MRD). MRD means a small number of cells remain during or after treatment. It predicts a poorer prognosis because patients are more likely to relapse again.
There are 2 types of ALL: B–cell ALL and T–cell ALL. Overall, B–cell ALL has a better treatment outlook than T–cell ALL.
About 30–50% of patients survive after their first relapse. Some children may relapse more than once. Each time the chance of cure decreases. Survival rates are only estimates. Your child’s doctor is the best source of information on your child’s case.
A diagnosis of relapsed or refractory leukemia is challenging for patients and families. Intense treatments may cause severe side effects and increase your child’s risk of infections.
Good communication with the care team can help patients and family caregivers know what to expect and take an active role in the treatment decisions.
A team of health care providers can support emotional, social, and spiritual needs of patients and families. Your care team may include:
Early palliative care can help with pain and other side effects. Common side effects include:
Doctors may prescribe medications to help with side effects. Other treatments may include integrative (complementary) medicine.
About half of children with relapsed or refractory ALL will develop life-threatening infections. Reasons infection may occur include:
Follow infection prevention guidelines to reduce your child’s risk of illness. Take steps to prevent infection:
Reviewed: November 2022