Treatment of acute lymphoblastic leukaemia.

When a child with acute lymphoblastic leukaemia is first diagnosed he may be severely anaemic, granulocytopenic, and thrombocytopenic; therefore, the immediate concern is to decide whether replacement therapy in the form of selected blood components is required, i.e. red cells, granulocytes, or platelets. This supportive therapy is obviously of prime importance as induction chemotherapy requires approximately 4 weeks to achieve a remission and during that period the child's life is threatened by either severe anaemia, infection, or haemorrhage. It has been amply shown that platelet-rich plasma can decrease severe haemorrhage in these children when threatened by thrombocytopenia (Han et al., 1966). Repeated packed cell transfusions, rather than whole blood, are often necessary in the early stages. Though there has been a suggestion that normal granulocytes harvested in sufficient quantities may be of aid in combating infection problems when there is granulocytopenia, this has not been widely accepted and presents, at this time, serious problems in supply. The child should be investigated as to the extent of the disease; that is, whether the central nervous system (CNS) is involved as well as other structures such as bone, kidneys, and testicles. Involvement of these areas determines to some degree the type of therapy indicated. It is now appreciated that approximately 50% of such children will eventually develop CNS leukaemia, and efforts must be directed to forestall and hopefully to prevent its development. Specific Therapy Acute leukaemia is a disease of unknown aetiology and is rarely curable; however, we have been able to achieve a steady improvement in our results, so that at present 20% of leukaemic children can expect to live 5 years without evidence of disease.