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acute Lymphocytic Leukemia stages

primarily childhood (ages 1-10)
remission induction (1-2 months;absence of symptoms, absence of hematologic alterations)> CNS prophylasis (1 month; high metastasis to the brain; continue throughout if pediatric)> consolidation (3-9 months; intensification; done to ride body of the cells)> Maintenance (30-36 months)

ALL remission induction drugs

vincristine, prednison, anthracuclin, L-asparaginase with peds

ALL CNS prophylaxis


ALL consolidation

same as remission (maybe cytarabine, 6-MP)

ALL Maintenance

methotrexate and 6-MP, VCR and prednisone


vinca alkaloid, microtubule inhibitor (M phase specific), substrate for MDR pump (increased drug efflux), causes neurotoxicity


corticosteroid, suppresses gene expression, Cushin-like effects and psychosis

Anthracycline (-rubicin)

intercalating agent and topoisomerase2 inhibitor (decreases DNA repair), free radicals, MDR substrate, cardiotoxicity (arrythmias; accumulation= CHF)


inhibits protein synthesis (makes Asp unavailable to malignant cells)


folate antimetabolite (some liver and lung fibrosis)


purine antimetabolite


pyrimidine antimetabolite


alkylating agent, hemorrhagic cystitis


disease increases with age (recurrence after age 60)
remission induction> consolidation . HSC ttransplant (if drug tx if not curative) or dictontinue therapy

AML remission induction

cytarabine and daunorubicin (7 and 2 regimen) and an etoposide if pediatric cases

AML consolidation drugs

same as ALL

Acute Promyelocytic Leukemia

ATRA is first choice (in t(15,17): promotes cellular differentiation and reduces proliferation
Arsenic trioxide (increased degradation of product of mutation): promotes differentiation, induces apoptosis
gemtuzumab (CD33 antibody)-ozogamicin (antibody intercalating agent)


in 50s nd 60s
Imatinib (ABL tyrosine kinase inhibitors; not curative)
Interferon- (alpha- antiproliferative agent), plus cytarabine
Hydroxyurea ( inhibits DNA synthesis; ribonucleaotide reductase)

Chronic Lymphocytic Leukemia

disease of the elderly, chronic environmental exposure
Fludaribine or cladribine (purine analog; inhibitor of DNA synthesis) plus cyclophosphamide OR
cyclophosphamide and prednisone (suppresses cellular signaling) often PLUs
Rituximab (mab to CD20; mouse/human) OR
Alemtuzumab (mab to CD 53) or Ofatumumab (CD 20)

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