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Prognosis for acute lymphoblastic leukemia
Last reviewed: 23.04.2024
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Each of the modern protocols for the treatment of acute lymphoblastic leukemia poses its problems, the solution of which is poured into the general international course to optimize the therapy of this disease. For example, in the Italian version of the BFM-AIEOP protocol, the researchers left cranial irradiation only for children with hyperleukocytosis exceeding 100,000 cells per μL and with the T-cell variant of acute lymphocytic leukemia, while achieving adequate control over the occurrence of neurorecidivitis.
The German-Austrian BFM group found the crucial importance of an early response (reduction in tumor mass) to 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 group (Children's Cancer Group, USA) is to improve the results of therapy by intensifying the treatment of patients from the middle-risk group. EFS - event-free survival (EFS) - at the same time increased from 75 to 84% (p <0.01), but replacing prednisolone dexamethasone reduced the number neyroretsidivov and increased overall survival. The protocols of the DFCI (Dana-Farber Cancer Institute, USA) focus on the replacement of conventional cranial irradiation with hyperfraction, which reduces the likelihood of late complications. This group also deals with the problem of angiogenesis of leukemia and the possibility of using anti-angiogenic drugs in the therapy of the disease. In this version of the protocol, a test for drug susceptibility in vitro (MTT test with methylthiazolyltetrazolium) to the main antileukemic drugs - prednisolone, vincristine, daunorubicin and asparaginase is investigated as one of the prognostic factors . The French followers of the BFM (FRALLE) protocol showed the same efficacy of high-dose and moderate-dose methotrexate in patients in the group of standard and moderate risk and the absence of colony-stimulating factors in survival. Northern
The Society for Pediatric Hematology and Oncology (NOPHO, Norway, Denmark, Sweden) examines the prognostic and clinical significance of determining the minimum residual disease in the treatment of acute lymphoblastic leukemia, and also optimizes maintenance therapy for pharmacological parameters (measurement of metabolites of mercaptopurine and methotrexate). POG (Pediatric Oncology Group, USA) focuses on minimizing therapy in children with good initial prognostic factors (leukocytosis less than 50,000 in μL, 1-9 years old, DNA index> 1.16, trisomy chromosomes 4 and 10), observed in 20% of cases of B-linear acute lymphocytic leukemia (survival in this group is 95%). St.Jude Children's Research Hospital (SICRH, USA) offers individualized therapy depending on the clearance of cytotoxic drugs. The general tendency is to reduce the toxicity of the therapy (for example, to reduce the number of patients who need cranial irradiation due to intensive intrathecal and systemic therapy). Different researchers offer their treatment options for high-risk patients - from the introduction of high-dose cytarabine to children under the age of one year before allogeneic bone marrow transplantation for all children with an unfavorable prognosis.
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