Dr. Angiolillo on the Toxicity Profile of Traditional Treatment in Pediatric B-ALL

Anne Angiolillo, MD, director, Leukemia and Lymphoma Program, Children’s National Hospital, discusses the adverse effects (AEs) that are associated with traditional treatment in pediatric B-cell acute lymphoblastic leukemia (B-ALL).

B-ALL is the most commonly diagnosed childhood cancer, explains Angiolillo. Historically, the survival rates of pediatric patients with standard-risk B-ALL were low but have risen over decades to upward of 90%, Angiolillo says. Although patients now have excellent outcomes, strategies are needed to mitigate the toxicities associated with traditional vincristine and dexamethasone pulses.

Dexamethasone is associated with several AEs, including mood changes, irritability, increased appetite, sleep disturbances, and bone/joint pain, whereas vincristine can cause sensory and motor neuropathy, Angiolillo says.

The AALL0932 trial showed positive outcomes with maintenance vincristine/dexamethasone pulses every 12 weeks despite patients receiving one-third less treatment compared with traditional pulses every 4 weeks. The findings suggest that the reduced frequency approach could be incorporated into frontline B-ALL treatment to decrease the burden of therapy for patients’ families and improve quality of life, concludes Angiolillo.