Relapsed Acute Lymphoblastic Leukemia

• The children we treat for ALL have better outcomes than the national average.
• Your child will benefit from the work of physician-scientists at Fred Hutchinson Cancer Center and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has named our partnership a comprehensive cancer center.

• In addition to standard diagnostics, our team uses state-of-the-art tests like molecular profiling and next-generation sequencing (NGS). We examine your child's cancer cells for certain proteins that can serve as targets for treatment and starting points for the design of new drugs.
• These tests help us find what is different about your child’s leukemia and identify the best treatment options for them. Whenever possible, we use results from NGS to match your child with therapies that target their specific cancer. This approach is called precision (or personalized) medicine. These therapies could be medicines already approved for another disease or clinical trials of new treatments.
• In addition to targeted therapies, we offer advanced treatment options such as new mixes of chemotherapy, immunotherapy, radiation therapy and stem cell transplants.

• Our physician-scientists are world leaders in improving care and cure rates for leukemia.
• The High-Risk Leukemia Program will coordinate all aspects of your child’s care. Meet our High-Risk Leukemia team.
• You will have a single point of contact who will communicate among all members of your child’s team – including you.
• To create a custom treatment plan for your child, our whole team will discuss your child’s case in detail. Such close collaboration by experts in many different specialties sets us apart. This plan guides your child’s care through all phases of their treatment and follow-up care.
• Your child will have comprehensive visits with our High-Risk Leukemia team at key milestones. They will see a pediatric oncologist, transplant doctor, advanced practice provider (APP), nurse coordinator, pharmacist, social worker and child life specialist.
• We care for your whole child. We don’t just treat their disease. As needed, your child will receive care from specialists in nutrition, pain management, pharmacy, palliative care, physical therapy and emotional health. Read more about the supportive care we offer.
• We know that teens and young adults with cancer have different challenges than young children. Our Adolescent and Young Adult Cancer Program focuses on their needs, which may include fertility preservation.

• For most children with relapsed or refractory ALL, treatment includes a stem cell transplant to replace their body's system for making blood cells and introduce a new immune system. This reduces the risk of leukemia relapse. Our team will work with your family through the whole process — preparing for transplant, doing the transplant here at Seattle Children’s and caring for your child as they recover.
• We work closely with Fred Hutch, whose doctors pioneered this lifesaving procedure 40 years ago. The Hutch is one of the busiest transplant centers in the world.
• Dr. Marie Bleakley co-director of our High-Risk Leukemia Program, runs a research lab at Fred Hutch and leads a phase 1 clinical trial of T-cell therapy for patients with acute leukemia that persists after a donor stem cell transplant. She also leads a national clinical trial of a new way to transplant stem cells in youth with leukemia, pioneered by her team.

• Our physician-scientists are known worldwide for research on the biology of ALL and promising treatments. We lead research studies of new therapies, with the goal of finding cures for all children with ALL.
• We are key players in a global precision medicine effort that aims to transform treatment for children with hard-to-treat acute leukemia. Dr. Todd Cooper, co-director of our High-Risk Leukemia Program, holds a lead role.
• As leaders in cancer research, we can offer the very latest treatments being studied, including phase 1 clinical trials. These early studies are especially relevant for children with high-risk or relapsed ALL.
• We have one of the nation’s largest pipelines of CAR T-cell immunotherapy trials for children and young adults
• We offer clinical trials of treatments developed here at Seattle Children’s and through our membership in the Children's Oncology Group, the Pediatric Early Phase-Clinical Trial Network and Therapeutic Advances in Childhood Leukemia (TACL).
• Read more about cancer research and clinical trials at Seattle Children’s.

• Learning that your child’s ALL is high-risk or has relapsed can be scary. We help take positive steps right away by offering appointments in 1 to 3 days to children suspected to have cancer.
• During visits, we help you fully understand your treatment options and make the choices that are right for your family.
• Our intake coordinators, nurse coordinators, child life specialists and social workers are here for your family throughout your child’s care. We connect you to community resources and support groups.
• We work with children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

New targeted therapies have been created for some types of ALL. These new medicines target the specific genes and proteins involved in the growth and survival of cancer cells.

Targeted therapies we offer include:

• Tyrosine kinase inhibitors (TKIs) that stop stem cells from turning into ALL cells. TKIs are used to treat a rare type of ALL that has an abnormal chromosome (“Philadelphia chromosome”) in its cells.
• Immune system proteins (antibodies) made in the lab to fight disease. Doctors are studying a type of antibody that binds to 2 different proteins at the same time. This brings ALL cells and immune cells together and triggers an immune system attack.

Most often, targeted therapy is given along with chemotherapy.

Experts in our High-Risk Leukemia Program will work hard to find the best research study for your child’s ALL. For children with ALL that is harder to treat, these new therapies could put ALL into remission that lasts or that allows them to undergo a stem cell transplant that might cure them. Your child’s doctor will talk with you about any new options that might help your child. Then you can decide if you want to take part. It is always your choice.

At Seattle Children’s these include:

• Clinical trials offered through the Children's Oncology Group, the Pediatric Early Phase-Clinical Trial Network, the Therapeutic Advances in Childhood Leukemia (TACL) consortium and drug companies
• Phase 1 and phase 2 trials of CAR T-cell therapy (PLAT studies) for children and young adults with refractory or relapsed ALL
• A phase 1 trial testing a new T-cell therapy (HA-1 T TCR immunotherapy) for patients whose leukemia persists after a stem cell transplant
• Better approaches to stem cell transplant that aim to increase effectiveness and reduce side effects

Learn more about cancer clinical trials at Seattle Children’s

• You can search for many clinical trials available through Seattle Children’s on our Current Research Studies page or on ClinicalTrials.gov. Read our guide about searching for trials on ClinicalTrials.gov (PDF).
• Contact us at 206-987-2106.
• Email us.

To treat relapsed and refractory ALL, we use different chemotherapy than for newly diagnosed ALL. Some anticancer medicines are part of standard treatment, and others are being studied in clinical trials. Researchers are testing new mixes of medicines to find the best ones for each type of ALL.

Our patients get chemotherapy at our hospital campus in Seattle.  As much as possible, we will treat your child at our outpatient clinic. But at times they also will need to stay overnight in our hospital’s Cancer and Blood Disorders Center - Inpatient.

See more about getting chemotherapy at Seattle Children’s.

If your child’s cancer has spread or may spread to the brain, spinal cord or testicles, your child’s doctors may suggest radiation to one of those areas. Doctors also may use radiation to prepare your child’s body for a stem cell transplant.

Radiation uses high-energy beams to kill cancer cells. A machine outside the body delivers strong beams of X-rays. We focus beams as precisely as possible to help limit damage to healthy areas.

Our radiation oncologist, Dr. Ralph Ermoian, helps your child’s team decide if radiation may be helpful and what type of radiation to use. We work with you and your child to protect their ability to have biological children (fertility preservation).

Children treated for ALL at Seattle Children’s receive radiation therapy through our partner UW Medicine.

Learn more about Seattle Children's Radiation Therapy Service.

For most children with refractory or relapsed ALL and for babies younger than 1 year, treatment includes a transplant of hematopoietic (him-at-oh-poy-EH-tik) stem cells. These are young cells that grow into different types of blood cells.

Your child’s oncologist and transplant doctor will work together closely to decide:

• How to get your child's disease in remission, including new approaches like immunotherapy
• The best kind of transplant for your child
• How to reduce the risk of cancer coming back

We do the transplants here at Seattle Children's, working closely with our partner Fred Hutch. Fred Hutch is one of the largest stem cell transplant centers in the world.

First your child will get large amounts (high doses) of chemotherapy. They may also get radiation. This kills cancer cells and makes space for the new stem cells your child will get during the transplant.

Then your child receives stem cells through their vein. The cells have been taken from a healthy family member or other donor. These healthy cells then create new bone marrow.

Learn more about the Pediatric Blood and Marrow Transplant Program.

Relapsed and refractory ALL and its treatments may cause severe symptoms and side effects for your child. Their body is less able to make blood cells needed to fight infection, make blood clot and carry oxygen around their body. This means they have a higher chance of serious infection, bleeding and other problems.

As needed, your child will get transfusions to replace lost blood cells and antibiotics to treat or prevent infections. Expert nurses and doctors will watch your child closely. Based on how your child is doing, we adjust their treatment and supportive care.

We provide many types of supportive care to ease your child’s symptoms and side effects. As needed, your child and family will get care from specialists in nutrition, pain management, pharmacy, palliative care and emotional health.