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Acute lymphocytic leukemia of childhood: the problem of relapses
G K Rivera1, V Santana, H Mahmoud
1Department of Hematology-Oncology, St Jude Children's Research Hospital, University of Tennessee, College of Medicine, Memphis.
Insights
Identifying high-risk acute lymphoblastic leukemia patients early can guide therapy. Bone marrow transplant is recommended for short remissions, while intensive chemotherapy suits longer remissions.
Area of Science:
- Hematology
- Pediatric Oncology
Background:
- Acute lymphoblastic leukemia (ALL) has a significant relapse rate.
- Identifying patients likely to relapse at diagnosis is crucial for improving outcomes.
Purpose of the Study:
- To identify prognostic factors for relapse in acute lymphoblastic leukemia.
- To guide therapeutic strategies for relapsed ALL based on remission duration and patient subgroups.
Main Methods:
- Analysis of patient subgroups including infants, Philadelphia chromosome-positive, and B-cell ALL.
- Evaluation of remission duration as a key prognostic indicator.
- Comparison of bone marrow transplantation versus intensive chemotherapy for relapsed ALL.
Main Results:
- Infants, Philadelphia chromosome-positive, and B-cell ALL patients are potential candidates for experimental therapies.
- Length of initial remission is the most critical factor for successful relapse therapy.
- Bone marrow transplantation is recommended for relapses after short initial remissions (≤18 months).
Conclusions:
- Intensive chemotherapy offers comparable cure potential to transplantation for late relapses (>18 months) due to lower treatment-related mortality.
- Therapeutic decisions for relapsed ALL should consider remission duration and patient-specific factors.
- Further research is needed to optimize treatment for patients relapsing on contemporary ALL regimens.
Abstract:
Developing improved therapy for the one-third or more of patients who can be expected to relapse after initial treatment for acute lymphoblastic leukemia would be less difficult if one could identify potential failures unequivocally at diagnosis. Subgroups of patients who should be considered candidates for highly experimental therapy include infants (less than 1 year of age), patients with the Philadelphia chromosome and perhaps patients with B-cell leukemia. The most important factor that determines the success of therapy after relapse is the length of the patient's initial remission. We recommend bone marrow transplantation for children whose first remission did not exceed 18 months. For all others, it appears that intensive chemotherapy affords as great a potential for cure as one could expect from transplantation. We favor intensive chemotherapy over transplantation in cases of late bone marrow relapse (greater than 18 months), because of the currently high peritransplantation mortality rate. It is not clear whether either modality will be adequate for patients relapsing on contemporary treatment programs.