How the drugs work

Every drug on this page ends up stopping leukemia cells from multiplying. This one attacks the last step: the scaffolding a dividing cell builds to pull its two sets of instructions apart.

Everyday analogy: a jammed curtain track

• Vincristine Oncovin Stops cells from dividing by jamming the scaffolding they build to pull their chromosomes apart.

Not chemo. A signal that tells leukemia cells to shut themselves down. One of the strongest weapons against this disease.

Everyday analogy: a letter that starts closing time

• Dexamethasone Decadron A steroid that tells leukemia cells to shut themselves down. Not chemo, but one of the strongest drugs against this disease.
• Prednisolone / prednisone The milder steroid. Same job as dexamethasone: tells leukemia cells to shut themselves down.

Wedges into, or staples together, the DNA of cells that are dividing, so the instructions cannot be untangled or copied.

Everyday analogy: a wedge in the tailor’s seam, or glue in a zip

• Daunorubicin anthracycline The red one. Wedges into DNA and traps the enzyme that untangles it. The total amount a child ever gets is counted.
• Doxorubicin Adriamycin, anthracycline Daunorubicin's cousin. Same red color, same job, counted toward the same lifetime total.
• Cyclophosphamide Cytoxan Switched on by the liver, then staples the two strands of DNA together so a dividing cell cannot copy them.

Leukemia cells cannot make one nutrient, asparagine, for themselves. These enzymes clear it out of the blood.

Everyday analogy: a workshop that runs out of wheels

• Calaspargase pegol (Asparlas) cal-PEG A longer-lasting asparaginase. Starves leukemia cells of an amino acid they cannot make for themselves.
• Pegaspargase (Oncaspar) PEG-asp The standard long-acting asparaginase. Removes an amino acid leukemia cells depend on.
• Rylaze (Erwinia asparaginase) Asparaginase from a different bacterium, used when a child reacts to the usual one.

Slips a fake part into the copy of the DNA a dividing cell is making, so the copy fails.

Everyday analogy: faulty bricks that stop the build

• Mercaptopurine (6-MP) Purixan, Purinethol The nightly maintenance pill. Fakes a DNA building block; the dose is tuned to blood counts.
• Cytarabine (ara-C) Cytosar Fakes a DNA building block so dividing leukemia cells cannot copy themselves. Often given as a run of shots.
• Thioguanine (6-TG) Tabloid Mercaptopurine's sibling; fakes a DNA building block. Used in short bursts in some protocols.

Blocks the vitamin, folate, that a cell uses to make DNA parts. Three routes into the body, one drug.

Everyday analogy: jamming a shared pencil sharpener

• Methotrexate — weekly pills MTX, weekly methotrexate The weekly maintenance-pill version of the same drug, at a small dose.
• Methotrexate — IV (Capizzi / high-dose) HD-MTX, escalating methotrexate The big infusions with the hospital stay. Blocks a vitamin cells need to make DNA; leucovorin rescues the healthy ones after.
• Methotrexate — intrathecal (spinal) IT MTX, ITT, triple intrathecal Methotrexate put into the spinal fluid during a lumbar puncture, because most chemo cannot reach there.

Lab-made antibodies that latch onto a marker on the leukemia cell’s surface. Blinatumomab then holds your child’s own immune cell against it; inotuzumab carries a toxin inside.

Everyday analogy: a connector that brings a worker to the right house, or a parcel that brings a cutter indoors

• Blinatumomab (Blincyto) Holds one of your kid's own immune cells against a leukemia cell so the immune cell can kill it. Runs as a continuous drip.
• Inotuzumab (Besponsa) An antibody that finds the CD22 marker on leukemia cells and delivers a toxin straight inside them.

Not chemo. Given so healthy cells can recover after the big methotrexate doses.

Everyday analogy: a delivery of already-sharp pencils

• Leucovorin rescue folinic acid Not chemo. The antidote given after high-dose methotrexate so healthy cells can recover.