title: Relapsed or refractory pediatric acute lymphoblastic leukemia: current and emerging treatments.
abstract: Relapsed acute lymphoblastic leukemia (ALL) represents a major cause of morbidity and mortality in pediatrics. With contemporary chemotherapy, >85% of patients with newly diagnosed ALL survive. Unfortunately, 20% of these patients will relapse and for these children, outcomes remain poor despite our best known chemotherapy protocols. Most of these children will achieve a second complete remission, but maintaining this remission remains difficult. Because relapsed ALL is such a significant cause of morbidity and mortality, it is the focus of much research interest. Efforts have been made and continue to focus on understanding the underlying biology that drives relapse. The role of hematopoietic stem cell transplantation in relapsed ALL remains unclear, but many clinicians still favor this for high-risk patients given the poor prognosis with current chemotherapy alone. It is important to use new drugs with little cross-resistance in the treatment of relapsed ALL. New classes of agents are currently being studied. We also discuss prognostic factors and the biology of relapsed ALL.
authors.affiliation: Division of HematologyOncologyStem Cell Transplant, Ann Robert H. Lurie Childrens Hospital of Chicago, Chicago, IL 60611, USA.
authors.forename: Alissa
authors.initials: A
authors.lastname: Martin
authors.forename: Elaine
authors.initials: E
authors.lastname: Morgan
authors.forename: Nobuko
authors.initials: N
authors.lastname: Hijiya
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D018365:Neoplasm, Residual; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D012008:Recurrence; D012074:Remission Induction
chemical_list: D000970:Antineoplastic Agents; D007155:Immunologic Factors