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Predicting relapse risk in childhood acute lymphoblastic leukaemia

Predicting relapse risk in childhood acute lymphoblastic leukaemia Intensive multi‐agent chemotherapy regimens and the introduction of risk‐stratified therapy have substantially improved cure rates for children with acute lymphoblastic leukaemia (ALL). Current risk allocation schemas are imperfect, as some children are classified as lower‐risk and treated with less intensive therapy relapse, while others deemed higher‐risk are probably over‐treated. Most cooperative groups previously used morphological clearance of blasts in blood and marrow during the initial phases of chemotherapy as a primary factor for risk group allocation; however, this has largely been replaced by the detection of minimal residual disease (MRD). Other than age and white blood cell count (WBC) at presentation, many clinical variables previously used for risk group allocation are no longer prognostic, as MRD and the presence of sentinel genetic lesions are more reliable at predicting outcome. Currently, a number of sentinel genetic lesions are used by most cooperative groups for risk stratification; however, in the near future patients will probably be risk‐stratified using genomic signatures and clustering algorithms, rather than individual genetic alterations. This review will describe the clinical, biological, and response‐based features known to predict relapse risk in childhood ALL, including those currently used and those likely to be used in the near future to risk‐stratify therapy. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png British Journal of Haematology Wiley

Predicting relapse risk in childhood acute lymphoblastic leukaemia

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References (119)

Publisher
Wiley
Copyright
Copyright © 2013 John Wiley & Sons Ltd
ISSN
0007-1048
eISSN
1365-2141
DOI
10.1111/bjh.12442
pmid
23808872
Publisher site
See Article on Publisher Site

Abstract

Intensive multi‐agent chemotherapy regimens and the introduction of risk‐stratified therapy have substantially improved cure rates for children with acute lymphoblastic leukaemia (ALL). Current risk allocation schemas are imperfect, as some children are classified as lower‐risk and treated with less intensive therapy relapse, while others deemed higher‐risk are probably over‐treated. Most cooperative groups previously used morphological clearance of blasts in blood and marrow during the initial phases of chemotherapy as a primary factor for risk group allocation; however, this has largely been replaced by the detection of minimal residual disease (MRD). Other than age and white blood cell count (WBC) at presentation, many clinical variables previously used for risk group allocation are no longer prognostic, as MRD and the presence of sentinel genetic lesions are more reliable at predicting outcome. Currently, a number of sentinel genetic lesions are used by most cooperative groups for risk stratification; however, in the near future patients will probably be risk‐stratified using genomic signatures and clustering algorithms, rather than individual genetic alterations. This review will describe the clinical, biological, and response‐based features known to predict relapse risk in childhood ALL, including those currently used and those likely to be used in the near future to risk‐stratify therapy.

Journal

British Journal of HaematologyWiley

Published: Jan 1, 2013

Keywords: ; ; ; ;

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