Risk factors for relapse in childhood acute lymphoblastic leukemia: prediction and prevention

Abstract

With current treatment regimens, survival rates for acute lymphoblastic leukemia (ALL) have improved dramatically since the 1980s, with current 5-year overall survival rates estimated at greater than 85%. This success was achieved, in part, through the implementation of risk-stratified therapy. Nevertheless, for a subgroup of patients (15-20%) with newly diagnosed ALL who will ultimately relapse, traditional risk assessment remains inadequate. The risk of relapse may be estimated on the basis of diagnostic features or early treatment response findings. Further progress in this field may thus come from refinement of predictive factors for relapse and treatment adaptation and from the identification of biological subsets of ALL patients who could benefit from specific target therapies. This article summarizes the aspects associated with the identification of predictive factors for relapse in childhood ALL and options available for prevention of disease recurrence.

A retrospective analysis of treatment‐related hospitalization costs of pediatric, adolescent, and young adult acute lymphoblastic leukemia

“…Relapsed patients require very intensive therapy including SCTs [29,30], and may receive newer agents/drugs [12], which are often expensive. Consistent with findings from other studies, patients nearing end-of-life had greater costs per-period than those who survived [31][32][33]. The first 6 months of ALL treatment were associated with highest costs.…”

Relapse of childhood acute lymphoblastic leukemia and outcomes at a reference center in Latin America: organomegaly at diagnosis is a significant clinical predictor

“…Those patients younger than 1 year and older than 10, with >50 × 10 9 /l white blood cells (WBCs), infiltration of the CNS and/or testis at presentation, T-cell ALL, CD10negative antigen, poor response to steroids, or with a lack of remission after 29 days of starting induction therapy, were considered to be at high risk and were treated accordingly [6,18]. Organomegaly and lymphadenopathy was documented by clinical examination.…”

“…The intensity of treatment in ALL is based on risk of relapse, predicted by a combination of clinical, cytogenetic, and morphological response criteria [5]. However, risk groups identified by these variables are fairly nonspecific because a great number of relapses occur in the standard-risk group [6]. Risk stratification is further improved by cytogenetics and minimal residual disease (MRD) studies.…”

Impact of polymorphisms in apoptosis‐related genes on the outcome of childhood acute lymphoblastic leukaemia

“…Despite intensification of therapy, 20% of children with acute lymphoblastic leukaemia (ALL) relapse (Ceppi et al, 2015).…”

“…British Journal of Haematology, 172, 371-383. Diop, F., Moia, R., Favini, C., Spaccarotella, E., De Paoli, L., Bruscaggin, A., Spina, V., Cerri, M., Deambrogi, C., Kodipad, A.A., Favini, S., Sagiraju, S., Jabangwe, C., Mauro, F.R., Del Giudice, I., Forconi, F., Cortelezzi, A., Zaja, F., Visco, C., Chiarenza, A., Rigolin, G. Impact of polymorphisms in apoptosis-related genes on the outcome of childhood acute lymphoblastic leukaemiaDespite intensification of therapy, 20% of children with acute lymphoblastic leukaemia (ALL) relapse (Ceppi et al, 2015).The different response to chemotherapy may be partially explained by inherited genetic variants, e.g. single nucleotide polymorphisms (SNPs) and copy number variants (CNVs).…”