Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Hematologic Malignancy Reports
Published in: Current Hematologic Malignancy Reports 5/2016

01-10-2016 | Acute Lymphocytic Leukemias (K Ballen, Section Editor)

Treatment of Childhood Acute Lymphoblastic Leukemia: Prognostic Factors and Clinical Advances

Authors: Lynda M. Vrooman, Lewis B. Silverman

Published in: Current Hematologic Malignancy Reports | Issue 5/2016

Login to get access

Abstract

While the majority of children and adolescents with newly diagnosed childhood acute lymphoblastic leukemia (ALL) will be cured, as many as 20 % of patients will experience relapse. On current treatment regimens, the intensity of upfront treatment is stratified based upon prognostic factors with the aim of improving cure rates (for those at the highest risk of relapse) and minimizing treatment-related morbidity (for lower-risk patients). Here we review advances in the understanding of prognostic factors and their application. We also highlight novel treatment approaches aimed at improving outcomes in childhood ALL.
Literature
1.
2.
Veerman AJ, Kamps WA, van den Berg H, et al. Dexamethasone-based therapy for childhood acute lymphoblastic leukaemia: results of the prospective Dutch Childhood Oncology Group (DCOG) protocol ALL-9 (1997-2004). Lancet Oncol. 2009;10:957–66.CrossRefPubMed
3.
Moricke A, Reiter A, Zimmermann M, et al. Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95. Blood. 2008;111:4477–89.CrossRefPubMed
4.
Vrooman LM, Stevenson KE, Supko JG, et al. Postinduction dexamethasone and individualized dosing of Escherichia Coli L-asparaginase each improve outcome of children and adolescents with newly diagnosed acute lymphoblastic leukemia: results from a randomized study—Dana-Farber Cancer Institute ALL Consortium Protocol 00-01. J Clin Oncol. 2013;31:1202–10.CrossRefPubMedPubMedCentral
5.
6.
Oskarsson T, Soderhall S, Arvidson J, et al. Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome. Haematologica. 2016;101:68–76.CrossRefPubMedPubMedCentral
7.
Mody R, Li S, Dover DC, et al. Twenty-five-year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. Blood. 2008;111:5515–23.CrossRefPubMedPubMedCentral
8.
Smith M, Arthur D, Camitta B, et al. Uniform approach to risk classification and treatment assignment for children with acute lymphoblastic leukemia. J Clin Oncol. 1996;14:18–24.PubMed
9.
Moricke A, Zimmermann M, Reiter A, et al. Prognostic impact of age in children and adolescents with acute lymphoblastic leukemia: data from the trials ALL-BFM 86, 90, and 95. Klin Padiatr. 2005;217:310–20.CrossRefPubMed
10.
Pieters R, Schrappe M, De Lorenzo P, et al. A treatment protocol for infants younger than 1 year with acute lymphoblastic leukaemia (Interfant-99): an observational study and a multicentre randomised trial. Lancet. 2007;370:240–50.CrossRefPubMed
11.•
Dreyer ZE, Hilden JM, Jones TL, et al. Intensified chemotherapy without SCT in infant ALL: results from COG P9407 (Cohort 3). Pediatr Blood Cancer. 2015;62:419–26. Event-free survival remained less than 50% overall in infant MLL-rearranged ALL on this Children’s Oncology Group study which evaluated shortened (46 weeks), intensified therapy. CrossRefPubMed
12.
Forestier E, Schmiegelow K. The incidence peaks of the childhood acute leukemias reflect specific cytogenetic aberrations. J Pediatr Hematol Oncol. 2006;28:486–95.CrossRefPubMed
13.
Stock W, La M, Sanford B, et al. What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children’s Cancer Group and Cancer and Leukemia Group B studies. Blood. 2008;112:1646–54.CrossRefPubMedPubMedCentral
14.
Ramanujachar R, Richards S, Hann I, et al. Adolescents with acute lymphoblastic leukaemia: outcome on UK national paediatric (ALL97) and adult (UKALLXII/E2993) trials. Pediatr Blood Cancer. 2007;48:254–61.CrossRefPubMed
15.
DeAngelo DJ, Stevenson KE, Dahlberg SE, et al. Long-term outcome of a pediatric-inspired regimen used for adults aged 18-50 years with newly diagnosed acute lymphoblastic leukemia. Leukemia. 2015;29:526–34.CrossRefPubMed
16.
Grace RF, Dahlberg SE, Neuberg D, et al. The frequency and management of asparaginase-related thrombosis in paediatric and adult patients with acute lymphoblastic leukaemia treated on Dana-Farber Cancer Institute consortium protocols. Br J Haematol. 2011;152:452–9.CrossRefPubMed
17.
Liu C, Yang W, Devidas M, et al. Clinical and genetic risk factors for acute pancreatitis in patients with acute lymphoblastic leukemia. J Clin Oncol. 2016;34(18):2133–40.CrossRefPubMed
18.
Hunger SP, Lu X, Devidas M, et al. Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children’s oncology group. J Clin Oncol. 2012;30:1663–9.CrossRefPubMedPubMedCentral
19.
Paulsson K, Johansson B. High hyperdiploid childhood acute lymphoblastic leukemia. Genes Chromosomes Cancer. 2009;48:637–60.CrossRefPubMed
20.
Dastugue N, Suciu S, Plat G, et al. Hyperdiploidy with 58-66 chromosomes in childhood B-acute lymphoblastic leukemia is highly curable: 58951 CLG-EORTC results. Blood. 2013;121:2415–23.CrossRefPubMed
21.•
Moorman AV, Ensor HM, Richards SM, et al. Prognostic effect of chromosomal abnormalities in childhood B-cell precursor acute lymphoblastic leukaemia: results from the UK Medical Research Council ALL97/99 randomised trial. Lancet Oncol. 2010;11:429–38. This analysis presents cytogenetic data from a large cohort of 1725 children with B acute lymphoblastic leukemia included in the UK Medical Research Council ALL97/99 study, with median follow-up of 8.2 years. CrossRefPubMed
22.
Pui CH, Chessells JM, Camitta B, et al. Clinical heterogeneity in childhood acute lymphoblastic leukemia with 11q23 rearrangements. Leukemia. 2003;17:700–6.CrossRefPubMed
23.
Biondi A, Schrappe M, De Lorenzo P, et al. Imatinib after induction for treatment of children and adolescents with Philadelphia-chromosome-positive acute lymphoblastic leukaemia (EsPhALL): a randomised, open-label, intergroup study. Lancet Oncol. 2012;13:936–45.CrossRefPubMedPubMedCentral
24.
25.
Mullighan CG, Jeha S, Pei D, et al. Outcome of children with hypodiploid ALL treated with risk-directed therapy based on MRD levels. Blood. 2015;126:2896–9.CrossRefPubMed
26.
27.
Stengel A, Schnittger S, Weissmann S, et al. TP53 mutations occur in 15.7% of ALL and are associated with MYC-rearrangement, low hypodiploidy, and a poor prognosis. Blood. 2014;124:251–8.CrossRefPubMed
28.
Muhlbacher V, Zenger M, Schnittger S, et al. Acute lymphoblastic leukemia with low hypodiploid/near triploid karyotype is a specific clinical entity and exhibits a very high TP53 mutation frequency of 93%. Genes Chromosomes Cancer. 2014;53:524–36.CrossRefPubMed
29.
Loh ML, Goldwasser MA, Silverman LB, et al. Prospective analysis of TEL/AML1-positive patients treated on Dana-Farber Cancer Institute Consortium Protocol 95-01. Blood. 2006;107:4508–13.CrossRefPubMedPubMedCentral
30.
Harrison CJ, Moorman AV, Schwab C, et al. An international study of intrachromosomal amplification of chromosome 21 (iAMP21): cytogenetic characterization and outcome. Leukemia. 2014;28:1015–21.CrossRefPubMed
31.
Moorman AV, Richards SM, Robinson HM, et al. Prognosis of children with acute lymphoblastic leukemia (ALL) and intrachromosomal amplification of chromosome 21 (iAMP21). Blood. 2007;109:2327–30.CrossRefPubMed
32.
Attarbaschi A, Mann G, Panzer-Grumayer R, et al. Minimal residual disease values discriminate between low and high relapse risk in children with B-cell precursor acute lymphoblastic leukemia and an intrachromosomal amplification of chromosome 21: the Austrian and German acute lymphoblastic leukemia Berlin-Frankfurt-Munster (ALL-BFM) trials. J Clin Oncol. 2008;26:3046–50.CrossRefPubMed
33.•
Moorman AV, Robinson H, Schwab C, et al. Risk-directed treatment intensification significantly reduces the risk of relapse among children and adolescents with acute lymphoblastic leukemia and intrachromosomal amplification of chromosome 21: a comparison of the MRC ALL97/99 and UKALL2003 trials. J Clin Oncol. 2013;31:3389–96. On the UK-ALL 2003 study, children with ALL with iAMP21 were treated as high risk, regardless of other presenting features. This study demonstrated that with higher intensity therapy (i.e., non-standard risk therapy), the previously described increased risk of relapse with iAMP21 was mitigated. CrossRefPubMed
34.•
Heerema NA, Carroll AJ, Devidas M, et al. Intrachromosomal amplification of chromosome 21 is associated with inferior outcomes in children with acute lymphoblastic leukemia treated in contemporary standard-risk children's oncology group studies: a report from the children’s oncology group. J Clin Oncol. 2013;31:3397–402. The Children’s Oncology Group reported that iAMP21 was associated with inferior EFS and OS in Standard Risk patients (treated with less intensive therapy), but for High Risk patients (treated with more intensive therapy), iAMP21 was not associated with statistically significant differences in EFS or OS, suggesting that high risk therapy appeared to abrogate the adverse prognostic significance of this abnormality. CrossRefPubMedPubMedCentral
35.
van der Veer A, Waanders E, Pieters R, et al. Independent prognostic value of BCR-ABL1-like signature and IKZF1 deletion, but not high CRLF2 expression, in children with B-cell precursor ALL. Blood. 2013;122:2622–9.CrossRefPubMedPubMedCentral
36.
37.•
Clappier E, Grardel N, Bakkus M, et al. IKZF1 deletion is an independent prognostic marker in childhood B-cell precursor acute lymphoblastic leukemia, and distinguishes patients benefiting from pulses during maintenance therapy: results of the EORTC Children’s Leukemia Group study 58951. Leukemia. 2015;29:2154–61. In this report of a large cohort of patients with Ph-negative B ALL treated on the EORTC-CLG trial 58951, patients with IKZF1-deleted ALL had significantly lower EFS compared with non-IKZF1 deleted cases. IKZF1 deletion was an independent predictor of outcome, retaining its prognostic importance in multivariable analysis. CrossRefPubMed
38.•
Roberts KG, Li Y, Payne-Turner D, et al. Targetable kinase-activating lesions in Ph-like acute lymphoblastic leukemia. N Engl J Med. 2014;371:1005–15. Detailed genomic analysis of 154 patients with Ph-like ALL identified kinase activating alterations in over 90% of patients, involving ABL1, ABL2, CRLF2, EPOR, JAK2, PDGFR, and other genes. The multiple genetic alterations appear to impact a limited number of signaling pathways, notably ABL-class and JAK-STAT pathways, suggesting the potential for targeted interventions. CrossRefPubMedPubMedCentral
39.
Roberts KG, Pei D, Campana D, et al. Outcomes of children with BCR-ABL1-like acute lymphoblastic leukemia treated with risk-directed therapy based on the levels of minimal residual disease. J Clin Oncol. 2014;32:3012–20.CrossRefPubMedPubMedCentral
40.
Coustan-Smith E, Mullighan CG, Onciu M, et al. Early T-cell precursor leukaemia: a subtype of very high-risk acute lymphoblastic leukaemia. Lancet Oncol. 2009;10:147–56.CrossRefPubMedPubMedCentral
41.
42.
Inukai T, Kiyokawa N, Campana D, et al. Clinical significance of early T-cell precursor acute lymphoblastic leukaemia: results of the Tokyo Children’s Cancer Study Group Study L99-15. Br J Haematol. 2012;156:358–65.CrossRefPubMed
43.
Wood B, Winter S, Dunsmore K. T-lymphoblastic leukemia (T-ALL) shows excellent outcome, lack of significance of the early thymic precursor (ETP) immunophenotype, and validation of the prognostic value of end-induction minimal residual disease (MRD) in children’s oncology group (COG) study AALL0434. Blood. 2014;124:abstr 1.
44.
Conter V, Valsecchi MG, Buldini B, et al. Early T-cell precursor acute lymphoblastic leukaemia in children treated in AIEOP centres with AIEOP-BFM protocols: a retrospective analysis. Lancet Haematol. 2016;3:e80–6.CrossRefPubMed
45.
Patrick K, Wade R, Goulden N, et al. Outcome for children and young people with Early T-cell precursor acute lymphoblastic leukaemia treated on a contemporary protocol, UKALL 2003. Br J Haematol. 2014;166:421–4.CrossRefPubMed
46.
Silverman LB, Gelber RD, Young ML, et al. Induction failure in acute lymphoblastic leukemia of childhood. Cancer. 1999;85:1395–404.CrossRefPubMed
47.
48.
Panzer-Grumayer ER, Schneider M, Panzer S, et al. Rapid molecular response during early induction chemotherapy predicts a good outcome in childhood acute lymphoblastic leukemia. Blood. 2000;95:790–4.PubMed
49.
Borowitz MJ, Devidas M, Hunger SP, et al. Clinical significance of minimal residual disease in childhood acute lymphoblastic leukemia and its relationship to other prognostic factors: a Children’s Oncology Group study. Blood. 2008;111:5477–85.CrossRefPubMedPubMedCentral
50.
Borowitz MJ, Wood BL, Devidas M, et al. Prognostic significance of minimal residual disease in high risk B-ALL: a report from Children’s Oncology Group study AALL0232. Blood. 2015;126:964–71.CrossRefPubMedPubMedCentral
51.
Sutton R, Venn NC, Tolisano J, et al. Clinical significance of minimal residual disease at day 15 and at the end of therapy in childhood acute lymphoblastic leukaemia. Br J Haematol. 2009;146:292–9.CrossRefPubMed
52.
Bartram J, Wade R, Vora A, et al. Excellent outcome of minimal residual disease-defined low-risk patients is sustained with more than 10 years follow-up: results of UK paediatric acute lymphoblastic leukaemia trials 1997-2003. Arch Dis Child. 2016;101:449–54.CrossRefPubMed
53.•
Vora A, Goulden N, Mitchell C, et al. Augmented post-remission therapy for a minimal residual disease-defined high-risk subgroup of children and young people with clinical standard-risk and intermediate-risk acute lymphoblastic leukaemia (UKALL 2003): a randomised controlled trial. Lancet Oncol. 2014;15:809–18. The randomized UKALL-2003 study demonstrated that intensification of therapy for non-high risk patients with high end induction MRD resulted in a superior event-free survival compared with those receiving standard therapy.CrossRefPubMed
54.•
Vora A, Goulden N, Wade R, et al. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial. Lancet Oncol. 2013;14:199–209. The UKALL-2003 trial tested de-intensification of therapy for non-high risk patients with low/favorable MRD, randomly assigning patients to receive one or two courses of delayed intensification. No significant difference in EFS was demonstrated, supporting the feasibility of treatment reduction in patients with favorable end-induction MRD.CrossRefPubMed
55.•
Bhatia S, Landier W, Hageman L, et al. 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children’s Oncology Group study. Blood. 2014;124:2345–53. This report from the Children’s Oncology Group (COG) demonstrated that poor adherence to oral 6-mercaptopuine, a key component of maintenance therapy in childhood ALL, is an important predictor of relapse.CrossRefPubMedPubMedCentral
56.
Bhatia S, Landier W, Shangguan M, et al. Nonadherence to oral mercaptopurine and risk of relapse in Hispanic and non-Hispanic white children with acute lymphoblastic leukemia: a report from the children’s oncology group. J Clin Oncol. 2012;30:2094–101.CrossRefPubMedPubMedCentral
57.
Kadan-Lottick NS, Ness KK, Bhatia S, et al. Survival variability by race and ethnicity in childhood acute lymphoblastic leukemia. JAMA. 2003;290:2008–14.CrossRefPubMed
58.
Harvey RC, Mullighan CG, Chen IM, et al. Rearrangement of CRLF2 is associated with mutation of JAK kinases, alteration of IKZF1, Hispanic/Latino ethnicity, and a poor outcome in pediatric B-progenitor acute lymphoblastic leukemia. Blood. 2010;115:5312–21.CrossRefPubMedPubMedCentral
59.
Xu H, Cheng C, Devidas M, et al. ARID5B genetic polymorphisms contribute to racial disparities in the incidence and treatment outcome of childhood acute lymphoblastic leukemia. J Clin Oncol. 2012;30:751–7.CrossRefPubMedPubMedCentral
60.
Bona K, Blonquist TM, Neuberg DS, et al. Impact of socioeconomic status on timing of relapse and overall survival for children treated on Dana-Farber Cancer Institute ALL Consortium Protocols (2000-2010). Pediatr Blood Cancer. 2016;63:1012–8.CrossRefPubMed
61.•
Conter V, Valsecchi MG, Parasole R, et al. Childhood high-risk acute lymphoblastic leukemia in first remission: results after chemotherapy or transplant from the AIEOP ALL 2000 study. Blood. 2014;123:1470–8. In a report from the AIEOP group, after adjusting for waiting time to HSCT, there was no benefit demonstrated for HSCT in first CR for patients with high end-consolidation (week 10-12) MRD. This study further illustrates the need for novel therapies for these patients. CrossRefPubMed
62.
Uckun FM, Nachman JB, Sather HN, et al. Clinical significance of Philadelphia chromosome positive pediatric acute lymphoblastic leukemia in the context of contemporary intensive therapies: a report from the Children’s Cancer Group. Cancer. 1998;83:2030–9.CrossRefPubMed
63.
Schultz KR, Bowman WP, Aledo A, et al. Improved early event-free survival with imatinib in Philadelphia chromosome-positive acute lymphoblastic leukemia: a children’s oncology group study. J Clin Oncol. 2009;27:5175–81.CrossRefPubMedPubMedCentral
64.•
Schultz KR, Carroll A, Heerema NA, et al. Long-term follow-up of imatinib in pediatric Philadelphia chromosome-positive acute lymphoblastic leukemia: Children’s Oncology Group study AALL0031. Leukemia. 2014;28:1467–71. This study supports the feasibility and efficacy of incorporation of TKI therapy into multi-agent therapy for Ph + ALL. CrossRefPubMedPubMedCentral
65.
Topp MS, Kufer P, Gokbuget N, et al. Targeted therapy with the T-cell-engaging antibody blinatumomab of chemotherapy-refractory minimal residual disease in B-lineage acute lymphoblastic leukemia patients results in high response rate and prolonged leukemia-free survival. J Clin Oncol. 2011;29:2493–8.CrossRefPubMed
66.
Topp MS, Gokbuget N, Stein AS, et al. Safety and activity of blinatumomab for adult patients with relapsed or refractory B-precursor acute lymphoblastic leukaemia: a multicentre, single-arm, phase 2 study. Lancet Oncol. 2015;16:57–66.CrossRefPubMed
67.
Topp MS, Gokbuget N, Zugmaier G, et al. Long-term follow-up of hematologic relapse-free survival in a phase 2 study of blinatumomab in patients with MRD in B-lineage ALL. Blood. 2012;120:5185–7.CrossRefPubMed
68.
Hoffman LM, Gore L. Blinatumomab, a Bi-specific anti-CD19/CD3 BiTE((R)) antibody for the treatment of acute lymphoblastic leukemia: perspectives and current pediatric applications. Front Oncol. 2014;4:63.CrossRefPubMedPubMedCentral
69.
70.•
Maude SL, Frey N, Shaw PA, et al. Chimeric antigen receptor T cells for sustained remissions in leukemia. N Engl J Med. 2014;371:1507–17. In this report, 30 children and adults with multiply relapsed or refractory ALL were treated with autologous CD19-directed CAR-modified T cells. Notably, 90% of patients in this heavily pre-treated grouped achieved complete remission, with 6-month EFS reported of 67% (95% CI 51-88) and OS of 78% (95% CI 65-95), demonstrating the potential for this treatment approach. CrossRefPubMedPubMedCentral
71.•
Lee DW, Kochenderfer JN, Stetler-Stevenson M, et al. T cells expressing CD19 chimeric antigen receptors for acute lymphoblastic leukaemia in children and young adults: a phase 1 dose-escalation trial. Lancet. 2015;385:517–28. This study of the use of of CD 19-directed CAR T-cells in patients aged 1-30 years, further demonstrates the feasibility, safety, and, anti-leukaemic activity of this treatment approach. CrossRefPubMed
72.
Hijiya N, Hudson MM, Lensing S, et al. Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia. JAMA. 2007;297:1207–15.CrossRefPubMed
73.
Goshen Y, Stark B, Kornreich L, et al. High incidence of meningioma in cranial irradiated survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007;49:294–7.CrossRefPubMed
74.
Armstrong GT, Reddick WE, Petersen RC, et al. Evaluation of memory impairment in aging adult survivors of childhood acute lymphoblastic leukemia treated with cranial radiotherapy. J Natl Cancer Inst. 2013;105:899–907.CrossRefPubMedPubMedCentral
75.
Sirvent N, Suciu S, Rialland X, et al. Prognostic significance of the initial cerebro-spinal fluid (CSF) involvement of children with acute lymphoblastic leukaemia (ALL) treated without cranial irradiation: results of European Organization for Research and Treatment of Cancer (EORTC) Children Leukemia Group study 58881. Eur J Cancer. 2011;47:239–47.CrossRefPubMed
76.
Vora A, Andreano A, Pui CH, et al. Influence of cranial radiotherapy on outcome in children with acute lymphoblastic leukemia treated with contemporary therapy. J Clin Oncol. 2016;34:919–26.CrossRefPubMed
77.
Lipshultz SE, Scully RE, Lipsitz SR, et al. Assessment of dexrazoxane as a cardioprotectant in doxorubicin-treated children with high-risk acute lymphoblastic leukaemia: long-term follow-up of a prospective, randomised, multicentre trial. Lancet Oncol. 2010;11:950–61.CrossRefPubMedPubMedCentral
78.
Chow EJ, Asselin BL, Schwartz CL, et al. Late mortality after dexrazoxane treatment: a report from the Children’s Oncology Group. J Clin Oncol. 2015;33:2639–45.CrossRefPubMedPubMedCentral
79.•
Asselin BL, Devidas M, Chen L, et al. Cardioprotection and safety of dexrazoxane in patients treated for newly diagnosed T-cell acute lymphoblastic leukemia or advanced-stage lymphoblastic non-Hodgkin lymphoma: a report of the Children’s Oncology Group Randomized Trial Pediatric Oncology Group 9404. J Clin Oncol. 2016;34:854–62. In this a report of the Pediatric Oncology Group 9404 trial which included random assignment of patients with T ALL or T lymphoblastic lymphoma to receive therapy with or without dexrazoxane prior to each dose of doxorubicin, dexrazoxane was found to be cardioprotective, based upon echocardiographic measurements of left ventricular function and structure, without difference in EFS between the two randomized arm, supporting the use of dexrazoxane in childhood ALL patients. CrossRefPubMed
Metadata
Title
Treatment of Childhood Acute Lymphoblastic Leukemia: Prognostic Factors and Clinical Advances
Authors
Lynda M. Vrooman
Lewis B. Silverman
Publication date
01-10-2016
Publisher
Springer US
Published in
Current Hematologic Malignancy Reports / Issue 5/2016
Print ISSN: 1558-8211
Electronic ISSN: 1558-822X
DOI
https://doi.org/10.1007/s11899-016-0337-y

Other articles of this Issue 5/2016

Current Hematologic Malignancy Reports 5/2016 Go to the issue

CART and Immunotherapy (M Ruella, Section Editor)

Chimeric Antigen Receptor T cells for B Cell Neoplasms: Choose the Right CAR for You

Acute Myeloid Leukemias (H Erba, Section Editor)

What Is the Optimal Induction Therapy for Younger Fit Patients With AML?

Myeloproliferative Disorders (C Harrison, Section Editor)

How We Identify and Manage Patients with Inadequately Controlled Polycythemia Vera

Myeloproliferative Disorders (C Harrison, Section Editor)

Investigation and Management of Erythrocytosis

Myeloproliferative Disorders (C Harrison, Section Editor)

Transient Abnormal Myelopoiesis and AML in Down Syndrome: an Update

Myeloproliferative Disorders (C Harrison, Section Editor)

The Use of Anagrelide in Myeloproliferative Neoplasms, with Focus on Essential Thrombocythemia
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits