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Acute Leukemia in Infants
Azada Ibrahimova1, Lauren Pommert1,2, Erin H Breese3,4
1Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7018, Cincinnati, OH, 45229, USA.
Insights
Infant leukemia, a rare and aggressive cancer in children under one, presents unique biological challenges. Current treatments show limited success, necessitating novel therapeutic strategies for better outcomes.
Area of Science:
- Pediatric Oncology
- Hematology
- Molecular Biology
Background:
- Infant leukemia is a rare, aggressive subgroup of pediatric acute leukemias.
- Characterized by unique, aggressive biology and high-risk molecular features.
- Associated with high rates of chemotherapy resistance.
Purpose of the Study:
- Review clinical presentation of infant leukemia.
- Discuss underlying molecular biology.
- Outline current and novel therapeutic approaches.
Main Methods:
- Review of clinical presentation.
- Analysis of molecular biology.
- Evaluation of current and novel treatment strategies.
Main Results:
- Infant leukemias exhibit high-risk molecular features and chemotherapy resistance.
- International trials improved understanding but failed to enhance outcomes with chemotherapy intensification.
- Current regimens cause significant toxicities.
Conclusions:
- Infants with leukemia remain challenging to treat.
- Need for collaborative efforts beyond cytotoxic chemotherapy.
- Incorporate targeted strategies, immunotherapy, and clinical trials for improved outcomes.
Purpose Of The Review:
Infant leukemia is a rare, distinct subgroup of pediatric acute leukemias diagnosed in children under 1 year of age and characterized by unique, aggressive biology. Here, we review its clinical presentation, underlying molecular biology, current treatment strategies, and novel therapeutic approaches.
Recent Findings:
Infant leukemias are associated with high-risk molecular features and high rates of chemotherapy resistance. International collaborative clinical trials have led to better understanding of the underlying molecular biology, refined risk-based stratification, and investigated the use of hematopoietic stem cell transplantation. However, intensification of chemotherapy has failed to improve outcomes, and current regimens are associated with significant treatment-related and long-term toxicities. Infants with leukemia remain a challenging group to treat. We must continue collaborative efforts to move beyond traditional cytotoxic chemotherapy, incorporate molecularly targeted strategies and immunotherapy, and increase access to clinical trials to improve outcomes for this high-risk group of patients.
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