Treatment of childhood leukemias

Contemporary protocols, featuring early intensive multiagent chemotherapy, will cure at least 65% of children with acute lymphoblastic leukemia and up to 40% of those with acute myeloid leukemia. In acute lymphoblastic leukemia, emphasis is placed on stringent risk assessment at diagnosis so that only those patients at high risk of relapse are treated aggressively, with less toxic treatments reserved for lower-risk patients. Treatment strategies are less risk-based in acute myeloid leukemia, although genetic analysis has begun to aid in establishing therapeutic options for individual patients (eg, high-dose chemotherapy, differentiation-inducing agents, and bone marrow transplantation). For children with either the adult or juvenile form of chronic myeloid leukemia, allogeneic bone marrow transplantation remains the only curative treatment. In the future, it may be possible to direct therapy to specific genetic lesions that have been recently identified in leukemic cells.