Low-risk relapsed acute lymphoblastic leukemia in children and young adults: what have we learnt and what's next?
Teena Bhatla1, Stacy Cooper2, Laura E Hogan3
1Children's Hospital of New Jersey at Newark Beth Israel, Newark, NJ, USA.
Insights
Relapsed acute lymphoblastic leukemia (ALL) in children remains challenging. This review focuses on improving outcomes for low-risk relapsed ALL by integrating immunotherapy with chemotherapy.
Area of Science:
- Pediatric Oncology
- Hematology
- Leukemia Research
Background:
- Outcomes for pediatric acute lymphoblastic leukemia (ALL) have improved, but 10-15% of children relapse.
- Relapsed ALL presents a significant challenge, with 5-year survival rates between 35-60%.
Purpose of the Study:
- To review current therapeutic strategies for low-risk (LR) relapsed ALL.
- To explore the integration of immunotherapy with chemotherapy for improved survival in relapsed ALL.
Main Methods:
- Review of contemporary therapeutic regimens for LR relapsed ALL.
- Analysis of recently completed and ongoing clinical trials.
- Identification of factors associated with favorable outcomes in relapsed ALL.
Main Results:
- Factors for favorable outcomes in relapsed ALL include later relapse, B-cell phenotype, isolated extramedullary relapse, and good initial response.
- Current research focuses on combining immunotherapy with chemotherapy to enhance survival.
- Therapeutic strategies aim to improve outcomes while reducing toxicity.
Conclusions:
- Optimizing treatment for LR relapsed ALL is crucial.
- Integrating immunotherapy into treatment regimens holds promise for improving survival rates.
- Ongoing trials are essential for advancing care in relapsed ALL.
Abstract:
While outcomes for newly diagnosed children with acute lymphoblastic leukemia (ALL) have improved over the last few decades, 10-15% will relapse. Outcomes for those children with relapse remains a challenge, with 5-year overall survival of approximately 35-60%. Large cooperative group trials have identified factors associated with favorable (low risk, LR) outcome at relapse, including later relapse, B-cell phenotype, isolated extramedullary relapse and a good response to initial re-induction therapy. Contemporary therapeutic regimens are aimed at improving outcomes, while decreasing toxicity. A main focus of current research involves how immunotherapy can be best incorporated with cytotoxic chemotherapy to improve survival in relapsed ALL. Here we review therapeutic strategies for LR relapse, including review of recently completed and ongoing trials.
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