title: Where do we stand in the treatment of relapsed acute lymphoblastic leukemia?
abstract: Acute lymphoblastic leukemia (ALL) is the most common and one of the most treatable cancers in children. Although the majority of children with ALL are now cured, 10%-20% of patients are predicted to relapse and outcomes with salvage therapy have been disappointing, with approximately only one-third of children surviving long-term after disease recurrence. Several prognostic factors have been identified, with timing of recurrence relative to diagnosis and site of relapse emerging as the most important variables. Despite heterogeneity in the elements of salvage therapy that are delivered in trials conducted internationally, outcomes have been remarkably similar and have remained static. Because most intensive salvage regimens have reached the limit of tolerability, current strategies are focusing on identifying new agents tailored to the unique biology of relapsed disease and identifying methods to develop these agents efficiently for clinical use. Recently, high-resolution genomic analyses of matched pairs of diagnostic and relapse bone marrow samples are emerging as a promising tool for identifying pathways that impart chemoresistance.
authors.affiliation: Division of Pediatric Hematology/Oncology, New York University Langone Medical Center, New York, NY, USA. elizabeth.raetz@nyumc.org
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Raetz
authors.forename: Teena
authors.initials: T
authors.lastname: Bhatla
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D019175:DNA Methylation; D023281:Genomics; D006801:Humans; D007223:Infant; D008495:Medical Oncology / Q000379:methods*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000473:pathology*; D011336:Probability; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome