Childhood acute lymphoblastic leukemia.
As cure rates in childhood acute lymphoblastic leukemia reach 80%, emphasis is increasingly placed on the accurate identification of drug-resistant cases, the elucidation of the mechanisms involved in drug resistance and the development of new therapeutic strategies targeted toward the pivotal molecular lesions. Pharmacodynamic and pharmacogenomic studies have provided rational criteria for individualizing therapy to enhance efficacy and reduce acute toxicity and late sequelae. Currently, assessment of the early response to treatment by measurement of minimal residual disease (MRD) is the most powerful independent prognostic indicator. MRD is affected by both the drug sensitivity of leukemic cells and the pharmacodynamic and pharmacogenetic properties of the host cells. Rapid advances in biotechnology and bioinformatics should ultimately facilitate the development of molecular diagnostic assays that can be used to optimize antileukemic therapy and elucidate the mechanisms of leukemogenesis. In the interim, prospective clinical trials have provided valuable clues that are further increasing the cure rate of childhood acute lymphoblastic leukemia.
Pui
Ching-Hon
CH
Department of Hematology-Oncology, St. Jude Children's Research Hospital, and Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. ching-hon.Pui@stjude.org
Relling
Mary V
MV
Campana
Dario
D
Evans
William E
WE
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D005544:Forecasting; D020022:Genetic Predisposition to Disease; D006801:Humans; D018365:Neoplasm, Residual / Q000175:diagnosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000209:etiology / Q000235:genetics* / Q000628:therapy*; D018570:Risk Assessment