Response to treatment

How quickly the leukemia cells disappear after treatment starts is also a factor in the child's prognosis. Some institutions test the bone marrow on the seventh and the fourteenth days of treatment. If a rapid reduction of blasts in the marrow has occurred within the first two weeks of treatment, then the child is considered an "early rapid responder" and may be placed onto a less intensive protocol (treatment plan). Other centers use response to a one-week trial of prednisone to separate children into risk categories. Scientists are now using special biochemical techniques to measure the amount of leukemia remaining in the bone marrow after four weeks of chemotherapy. This measure of residual leukemia (minimal residual disease—MRD) is 1,000 times more sensitive than looking at the bone marrow with a microscope. Some institutions now use MRD to help choose the most appropriate treatment.

All of the information above is used to determine what treatment is most appropriate for your child. Children at low or average risk of relapse need fewer and less toxic drugs than do those at high risk of relapse. However, most children with high-risk disease do very well when given more intensive treatment.

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