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In the past 10 to IS years there has been dramatic improvement in the survival of children with acute lymphoblastic leukemia. At the present time, over 50% of children with this disease will be alive and free of their disease at least 5 years from the time of their initial diagnosis. Although a number of factors have contributed to this improvement, perhaps none has been as important as the institution of central nervous system preventive therapy (eNS prophylaxis). However, despite the efficacy of eNS prophylaxis, the prevention and treatment of central nervous system leukemia continues to pose a formidable clinical challenge to the pediatric oncologist. Although successful in most cases, eNS preventive therapy remains ineffective for a small but significant subset of patients at high risk for developing eNS disease. Moreover, it has become increasingly evident that some methods of eNS preventive therapy are associated with long-term, adverse eNS sequelae. Thus, considerable controversy exists regarding the optimal method of eNS prophylaxis. Treatment of the patient who develops overt meningeal leukemia has not been as successful and continues to pose a major clinical challenge. Despite the ability of intrathecal chemotherapy and/or radiation therapy to induce eNS remission, most patients suffer subsequent relapse and ultimate survival is usually signifi cantly compromised. It is evident that newer approaches to treatment for this patient group must be identified before major improvement for this patient group is likely to occur.
This book provides a comprehensive and up-to-date review of all aspects of childhood Acute Lymphoblastic Leukemia, from basic biology to supportive care. It offers new insights into the genetic pre-disposition to the condition and discusses how response to early therapy and its basic biology are utilized to develop new prognostic stratification systems and target therapy. Readers will learn about current treatment and outcomes, such as immunotherapy and targeted therapy approaches. Supportive care and management of the condition in resource poor countries are also discussed in detail. This is an indispensable guide for research and laboratory scientists, pediatric hematologists as well as specialist nurses involved in the care of childhood leukemia.
With the fall in mortality from infectious diseases, the· impact of childhood cancer in the Western World has increased to become the second commonest cause of death in the age group 1-14 years, being surpassed only by accidents. However, even in those countries in which paediatric cancer is attracting increasing interest, the disease is relatively uncommon, and the number of cases seen by any one physician, even in a large general hospital, is often limited to one or two a year. The widely held view by parents and even by many doctors that cancer in childhood is usually untreatable and inevitably fatal is no longer tenable. With improvement in the therapeutic response or in the actual survival rates of children with such lesions as Wilms' tumour, brain tumours, rhabdomyosarcomas, Ewing's sarcoma, retinoblastoma, lym phoma and even leukaemia, there is a real hope of achieving a substantial reduction in the mortality of childhood cancer. Paediatric oncology is, in fact, providing a vigorous stimulus to the much wider field of cancer treatment and research, and is demonstrating the advantages of a multi-disciplinary cooperation in the management of this disease.
This book discusses key aspects of childhood acute lymphoblastic leukemia (ALL), presenting the latest research on the biology and treatment of the disease and related issues. The cure rate for ALL has improved dramatically due to advances such as supportive care, treatment stratification based on relapse risk, and the optimization of treatment regimens. Gathering contributions by eminent scholars Pediatric Acute Lymphoblastic Leukemia is a valuable resource for pediatric hematologists as well as for medical students, interns, residents and fellows. It not only offers comprehensive insights, but also provides a springboard for future research.