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Prognosis in acute lymphoblastic leukemia
Last reviewed: 04.07.2025
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Each of the modern protocols for the treatment of acute lymphoblastic leukemia sets its own tasks, the solution of which merges into the general international trend for optimizing the therapy of this disease. For example, in the Italian version of the BFM - AIEOP group protocol, researchers left cranial irradiation only for children with hyperleukocytosis exceeding 100,000 cells per μl and with the T-cell variant of acute lymphoblastic leukemia, having achieved adequate control over the occurrence of neurorelapses.
The German-Austrian BFM group discovered the fundamental importance of an early response (reduction in tumor mass) to the pre-phase treatment with prednisolone and intrathecal methotrexate and introduced this indicator as one of the most informative prognostic factors. The main achievement of the CCG (Children's Cancer Group, USA) is the improvement of therapy results by intensifying treatment of patients from the average risk group. Event-free survival (EFS) increased from 75 to 84% (p < 0.01), and the replacement of prednisolone with dexamethasone reduced the number of neurorelapses and increased overall survival. The protocols of the DFCI group (Dana-Farber Cancer Institute, USA) pay attention to the replacement of conventional cranial irradiation with hyperfractionated, which reduces the likelihood of late complications. This group also deals with the problem of leukemia angiogenesis and the possibility of using antiangiogenic drugs in the treatment of the disease. In the current version of the protocol, one of the prognostic factors is the in vitro drug susceptibility test (MTT test - methylthiazolyl tetrazolium test) to the main antileukemic drugs - prednisolone, vincristine, daunorubicin and asparaginase. French followers of the BFM group protocols (FRALLE) have shown the same effectiveness of high-dose and medium-dose methotrexate in patients from the standard and average risk groups and the absence of an effect of colony-stimulating factors on survival. Northern
The Society for Pediatric Hematology and Oncology (NOPHO; Norway, Denmark, Sweden) is investigating the prognostic and clinical significance of minimal residual disease determination in the treatment of acute lymphoblastic leukemia and is also engaged in optimization of maintenance therapy by pharmacological parameters (measurement of mercaptopurine and methotrexate metabolite concentrations). POG (Pediatric Oncology Group, USA) focuses on minimizing therapy in children with good initial prognostic factors (leukocytosis less than 50,000/μl, age 1-9 years, DNA index>1.16, trisomy of chromosomes 4 and 10), observed in 20% of cases of B-lineage acute lymphocytic leukemia (survival in this group is 95%). St. Jude Children's Research Hospital (SICRH, USA) suggests individualizing therapy depending on the clearance of cytotoxic drugs. The general trend is to reduce the toxicity of the therapy (for example, reducing the group of patients requiring cranial irradiation due to intensive intrathecal and systemic therapy). Various researchers offer their own treatment options for high-risk patients - from the introduction of high-dose cytarabine to children under one year of age to allogeneic bone marrow transplantation for all children with an unfavorable prognosis.
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