Some patients have a return of ALL cells in the marrow and a decrease in normal blood cells after remission. This is called a relapse.
Patients with relapsed ALL may be
- Treated with the same drugs as newly diagnosed patients
- Given different drugs
- Given an allogeneic stem cell transplantation if they have a matched donor.
Some patients still have ALL cells in their bone marrow after treatment. This is called refractory leukemia.
For patients with refractory ALL
- Drugs that were not used in the first round of treatment may be given
- An allogeneic stem cell transplant may also be a part of treatment.
The FDA has approved these drugs for relapsed and refractory patients.
- Liposomal vincristine (Marqibo®) is approved for adult patients with Ph chromosome-negative ALL who have relapsed two or more times. It is also approved for patients whose leukemia has progressed following two or more regimens of therapy.
- Nelarabine (Arranon®) is approved for patients with relapsed T-cell ALL.
- Blinatumomab (Blincyto®) is approved to treat patients with Ph chromosome-negative precursor B-cell ALL for patients whose cancer relapsed or was refractory.
- Clofarabine (Clolar®) is approved by the FDA to treat children (from age 1 to 21) with relapsed or refractory ALL after they have received at least two prior chemotherapy regimens.