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Review
. 2018 Dec:203:14-24.e2.
doi: 10.1016/j.jpeds.2018.07.039. Epub 2018 Sep 10.

Next-Generation Evaluation and Treatment of Pediatric Acute Lymphoblastic Leukemia

Emily B Heikamp  1 , Ching-Hon Pui  2
Affiliations
Review

Next-Generation Evaluation and Treatment of Pediatric Acute Lymphoblastic Leukemia

Emily B Heikamp et al. J Pediatr. 2018 Dec.
No abstract available

Keywords: cytotoxic chemotherapy; immunotherapy; minimal residual disease; next-generation sequencing; precision medicine; targeted therapy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1:
Figure 1:. Landmark advances in pediatric Acute Lymphoblastic Leukemia (ALL).
5-year overall survival data for pediatric ALL from the Surveillance, Epidemiology, and End Results (SEER) Program is overlaid with landmark advances in the treatment (white; left table) and in understanding the biology of pediatric ALL (black; right table).
Figure 2:
Figure 2:. Factors influencing risk stratification and outcome for patients with ALL.
Clinical presenting features, leukemia cell genetics (cancer genome), host germline genome and minimal residual disease should be considered when determining risk-adapted therapy. Advances in whole genome sequencing of both host (germline) and cancer (leukemia) genomes has deepened our understanding of genetic factors that determine risk (high-, intermediate-, and low-risk) and influence treatment response and toxicity of cytotoxic chemotherapy agents.
Figure 3:
Figure 3:. Mechanisms of therapy (molecular, epigenetic, and immunologic) for pediatric ALL.
Precision medicine has revolutionized treatment of pediatric ALL by providing novel molecular and epigenetic targets, in addition to immunotherapeutic approaches to cure patients with relapsed/refractory disease.
See this image and copyright information in PMC

References

    1. Pui CH, Yang JJ, Hunger SP, Pieters R, Schrappe M, Biondi A, et al. Childhood Acute Lymphoblastic Leukemia: Progress Through Collaboration. J Clin Oncol. 2015;33:2938–48. - PMC - PubMed
    1. Schrappe M, Camitta B, Pui CH, Eden T, Gaynon P, Gustafsson G, et al. Long-term results of large prospective trials in childhood acute lymphoblastic leukemia. Leukemia. 2000;14:2193–4. - PubMed
    1. Schrappe M, Nachman J, Hunger S, Schmiegelow K, Conter V, Masera G, et al. ‘Educational symposium on long-term results of large prospective clinical trials for childhood acute lymphoblastic leukemia (1985–2000)’. Leukemia. 2010;24:253–4. - PubMed
    1. Pui CH, Evans WE. A 50-year journey to cure childhood acute lymphoblastic leukemia. Semin Hematol. 2013;50:185–96. - PMC - PubMed
    1. Smith M, Arthur D, Camitta B, Carroll AJ, Crist W, Gaynon P, et al. Uniform approach to risk classification and treatment assignment for children with acute lymphoblastic leukemia. J Clin Oncol. 1996;14:18–24. - PubMed

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