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Work-up
H&P
CBC, leukocyte differential, platelets, electrolytes, liver function tests, PT, PTT, fibrinogen, LDH, uric acid
Bone marrow biopsy/aspirate
HLA typing for patients who are candidates for allogeneic hematopoietic cell transplantation
Cardiac scan if prior cardiac history or prior anthracycline use
CT/MRI of head if neurologic symptoms
CT chest for T-ALL patients
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Treatment regimens for acute lymphoblastic leukemia (ALL) have evolved empirically into complex schemes that use numerous agents in various doses, combinations, and schedules, and few of the individual components have been tested rigorously in randomized trials. However, the backbone of chemotherapy for ALL remains the sequence of induction, consolidation, and maintenance
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Remission induction: Most regimens include steroids, vincristine, an anthracycline, and usually asparaginase. Cyclophosphamide and cytarabine are often added. The combination of these agents results in CR rate to 80–90%; thus, treating physicians should use a regimen with which they are familiar and have experience in providing supportive care. See table below for different adult ALL regimens
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Consolidation: Eradication of minimal residual disease during hematologic remission is the primary aim of the consolidation phase. It is difficult to assess the value of individual components of treatment because the number, schedule, and combination of antineoplastic drugs vary considerably among studies. Consolidation therapy ...