Combination chemotherapy in relapsed childhood acute lymphoblastic leukemia

Chemotherapy for children with acute lymphoblastic leukemia who relapse during the course of initial treatment has been generally effective in inducing second complete remissions, but the duration of remissions has been very short. We used a combination of drugs, featuring weekly doses of L-asparaginase and cyclic boluses of dactinomycin, to maintain second complete remissions. Eight of ten patients who had had hematologic relapses subsequently entered a second complete remission, the median duration of which was 11.5 months. We conclude that this program resulted in a longer median duration of complete remission than most of the previously reported regimens for the treatment of relapsed childhood acute lymphoblastic leukemia. However, all patients eventually relapsed.