Researchers are currently investigating new treatments for ALL postremission. Participation in trials of these treatments will lead to improved therapies. If you wish to participate in a clinical trial, please talk to your doctor about the potential benefits and side effects of the treatment.

• Increased intensity and frequency of postremission treatments - The exact number and intensity of postremission treatments necessary to prevent leukemia recurrence without unacceptable side effects is still under investigation. Some patients with low risk factors could possibly benefit by a less intensive approach. Those with high risk factors, on the other hand, could benefit from a more intensive treatment program.
• Stem cell transplant - High-dose chemotherapy and stem cell transplant are superior postremission treatment options for many patients. In particular, patients with high risk for ALL relapse should consider transplant in first remission rather than after the disease recurs.
• New chemotherapy regimens - Development of new multidrug chemotherapy treatment regimens with new or additional anticancer therapies is an active area of clinical research. All new drugs for the treatment of patients with ALL are tested first in patients with relapsed or refractory disease. When they are found to be effective, they are evaluated as postremission treatment. New anticancer drugs that selectively kill T-lymphocytes are being evaluated in T-cell ALL. These include Arranon^® (nelarabine), forodesine, Campath-1H (alemtuzumab), and others.
• Gleevec® (imatinib mesylate) - Approximately 20 percent of ALL cases are caused by the Philadelphia chromosome. Patients who are Philadelphia chromosome positive typically do not respond well to standard therapies. Therefore, researchers continue to develop and explore new treatment strategies in an attempt to improve upon present treatment outcomes. Imatinib mesylate is a new type of therapy that has shown promise in producing anticancer responses in Philadelphia chromosome positive ALL patients who no longer respond to standard therapies. Side effects from treatment with imatinib mesylate have been generally mild. Physicians are working to combine imatinib mesylate into the overall treatment strategy for Ph-positive ALL. Such combinations of chemotherapy and imatinib are now producing survival rates of 60 percent at 3 years in Ph-positive ALL.
• Detection of minimal residual disease - Even after therapy, small numbers of cancer cells may be left in the bone marrow. These may grow and cause a recurrence of the cancer. In the past, researchers have not been able to test for the presence of these remaining cancer cells. As a result, they could not precisely predict who was likely to have a leukemia recurrence and who was not. Now, emerging evidence suggests that a test called the polymerase chain reaction (PCR) is able to detect a small number of remaining leukemia cells in patients with ALL-associated abnormal chromosomes. Studies show that the PCR test is more sensitive in cancer detection than previous tests, and can therefore predict ALL patients who are likely to have a leukemia recurrence. For this reason, there is potential for using PCR results to decide which patients may need further treatment, perhaps with more intensive therapy and a stem cell transplant.
• Treatment of minimal residual disease - Following postremission treatment, patients usually achieve a complete remission. Unfortunately, many patients in remission still experience a recurrence of leukemia. This is because not all the leukemia cells were destroyed. Doctors refer to this as a state of "minimal residual disease." Many doctors believe that applying additional treatments when only a few leukemia cells remain is the best approach to preventing the leukemia from returning. Treatments aimed at these residual cells can be administered over several weeks or months to eliminate any leukemia cells remaining in the body. These treatments include immunotherapy to activate the body's anticancer defense system, monoclonal antibodies, biologic response modifiers, and chemotherapy drugs.
• Monoclonal antibodies - Monoclonal antibodies are proteins that can be made in the laboratory and are designed to recognize and bind to very specific sites on a cell. This binding action promotes anticancer benefits by blocking the effects of growth factors. They also stimulate the immune system to attack and kill the cancer cells to which the monoclonal antibody is bound. This approach delivers additional treatment specifically to cancer cells and avoids harming the normal cells. Some monoclonal antibodies can locate cancer cells and kill them directly. Others have to be linked to a radioactive isotope or a toxin to kill cells. The antibodies act as a delivery system. Monoclonal antibodies can be given alone or with chemotherapy and are being evaluated to see if they can improve cure rates. These include Rituxan^® (rituximab) and Campath 1H (alemtuzumab).
• Maintenance chemotherapy - The value of lower dose maintenance therapies is well known in children with ALL, but the best drugs and dosages to use are still under investigation. The value of maintenance therapy in adults with various forms of ALL is more controversial than in children and is still being actively investigated.
• Prevention of brain recurrences - One study shows that in children who were considered to be at an average risk, but not at high risk for cancer recurrence, the combination of intensive systemic chemotherapy and chemotherapy delivered directly to the spinal cord was as effective, perhaps even more effective, than the use of systemic chemotherapy with radiation therapy to prevent the recurrence of ALL to the brain and spine. Further study about any long-term effect on a child's growth and development or neurologic function is needed.
• Supportive care - Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatments. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. To achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed.