UKALL 2003 Protocol

The UKALL 2003 protocol is a highly individualized treatment for pediatric patients with Acute Lymphoblastic Leukemia (ALL) at the Oxford University Medical Center. ALL accounts for 25% of all childhood cancer and 75% of all childhood leukemia. Most children with ALL show symptoms between two and five years of age. The goal of the UKALL 2003 protocol is bone marrow remission, which occurs in most cases.

UKALL 2003 Protocol

• Patients are diagnosed after blood tests and a bone marrow biopsy. Blood cell count and bone marrow test results help the doctor individualize the UKALL 2003 protocol for each pediatric patient. The UKALL 2003 protocol includes four drugs: vincristine, prednisolone/dexamethasone, L-aspiragenase and daunomycin. A bone marrow biopsy after 28 days of treatment usually shows remission.

  In one study of 38 patients aged 2 to 12 years old, as reported by the National Institutes of Health, 26 (68%) were boys whose average age was 5.4 years old. Twenty-eight days after starting treatment, 28 (74%) were in complete remission and 2 were in partial remission. Only one was not in remission. Seven (18%) died of sepsis during neutropenia, which occurs during chemotherapy because the child's immune system is weakened. Control of infections is crucial.

Vincristine

• Vincristine is intended for intravenous use only and can damage skin or muscle tissue if it leaks into tissues surrounding the IV. Vincristine attacks cancer cells to keep them from reproducing. Other drugs or medical conditions may interfere with vincristine therapy, including infections, blood abnormalities, and liver or muscle problems. Dizziness or lightheadedness may result. Vincristine can affect the bladder or urinary tract. Drinking large amounts of water and keeping lab tests current are recommended by the U.S. Food and Drug Administration. Minor side effects of vincristine include constipation, hair loss, nausea and vomiting. Severe side effects are rash, hives, difficulty breathing, swelling, cough, fever, hearing or vision loss, muscle weakness or numbness, and difficulty walking.

Asparaginase, Prednisolone and Daunomycin

• Derived from Escherichia Coli, asparaginase is administered in a hospital by a physician familiar with cancer chemotherapeutic agents. The oncologist must consider the benefits and risks of the drug, as one of its side effects is sudden death.

  Prednisolone counteracts the toxicity of other chemotherapy drugs. It is given 1 milligram and 5 milligram tablets without an enteric coating twice a day (up to 40 milligrams per day). Prednisolone can cause obesity, fluid and salt retention, hypertension, toxicity, irritability, necrosis and hyperglycemia. Dexamethasone is administered in 0.5 milligram and 2 milligram tablets or in liquid form up to 6 or 10 milligrams twice a day.

  Daunomycin powder, dissolved in sterile water, is injected.