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Review
. 2021 Apr 29;10(9):1926.
doi: 10.3390/jcm10091926.

Advances in the Diagnosis and Treatment of Pediatric Acute Lymphoblastic Leukemia

Hiroto Inaba  1   2 , Ching-Hon Pui  1   2
Affiliations
Review

Advances in the Diagnosis and Treatment of Pediatric Acute Lymphoblastic Leukemia

Hiroto Inaba et al. J Clin Med. .

Abstract

The outcomes of pediatric acute lymphoblastic leukemia (ALL) have improved remarkably during the last five decades. Such improvements were made possible by the incorporation of new diagnostic technologies, the effective administration of conventional chemotherapeutic agents, and the provision of better supportive care. With the 5-year survival rates now exceeding 90% in high-income countries, the goal for the next decade is to improve survival further toward 100% and to minimize treatment-related adverse effects. Based on genome-wide analyses, especially RNA-sequencing analyses, ALL can be classified into more than 20 B-lineage subtypes and more than 10 T-lineage subtypes with prognostic and therapeutic implications. Response to treatment is another critical prognostic factor, and detailed analysis of minimal residual disease can detect levels as low as one ALL cell among 1 million total cells. Such detailed analysis can facilitate the rational use of molecular targeted therapy and immunotherapy, which have emerged as new treatment strategies that can replace or reduce the use of conventional chemotherapy.

Keywords: acute lymphoblastic leukemia; advances; diagnosis; pediatric; treatment.

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Conflict of interest statement

The authors have no conflict of interest, including specific financial interests, relationships, or affiliations relevant to the subject of this manuscript.

Figures

Figure 1
Figure 1
Overall survival of pediatric patients with acute lymphoblastic leukemia treated in the St. Jude Total Therapy studies.
Figure 2
Figure 2
Distribution of genetic subtypes Genetic subgroups are listed based on the patients treated in St. Jude Total Therapy Study XVI and on patients with T-ALL who were treated in Children’s Oncology Group studies and evaluated for genetics as part of the Therapeutically Applicable Research to Generate Effective Treatments initiative [11,12]. Percentages are the approximate incidence in pediatric ALL. B-ALL is categorized as low-, intermediate-, or high-risk disease. For T-ALL, no genetic subtypes are clearly associated with outcomes, but the group as a whole is considered an intermediate-risk group. Abbreviations: ALL, acute lymphoblastic leukemia.
Figure 3
Figure 3
Immunotherapy in acute lymphoblastic leukemia. Abbreviations: ALL, acute lymphoblastic leukemia; CAR, chimeric antigen receptor; TSLPR, thymic stromal lymphopoietin receptor.
See this image and copyright information in PMC

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