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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.
The objective of the treatment of acute leukemia involves the eradication of all neoplastic cells, including the last one. Ideally, treatment should be controlled by monitoring cell kill. If the last cells could be discovered and their biological properties be determined, the qualitative and quantitative effects of treatment should be directly evaluable. This should ultimately permit a calculated tumor cell reduction thereby avoiding overtreatment and excessive toxicity and thus providing a basis for individualized antileukemic treatment. In recent years several new developments have contributed to the selective discovery of minimal numbers of leukemic cells which are hidden among the normal cells in the marrow cavities. These methods are the first steps to the realization of the therapeutic goals indicated above. They include the production and ap plication of monoclonal antibodies against differentiation antigens on the cell sur face, the use of pulse cytophotometry - and cell sorter techniques, the employment of cytogenetics, the development of culture techniques for selective growth of precursor cells and several others. These methodologies offer prospects for refined diagnosis and, as far as the elimination of leukemic cells is concerned, the further development of autologous bone marrow transplantation. Eliminating tumor cells from autologous grafts requires the detailed knowledge of the cellular inter relationships within the neoplasm so that the neoplastic cells responsible for tumor propagation are specifically removed. Recognition and characterization of the clonogenic cells of the neoplasm should then lead to determining their sensitivity to the therapeutic agents which are clinically applied.
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.
Brain metastases are the most dreaded complication of systemic cancer, affecting some 170,000 people a year, a far greater incidence than primary brain tumors. This book presents current information on the presentation and management of patients with brain metastases, providing available data, giving guidelines that can be applied in day to day practice, updated information for neurosurgeons, radiation oncologists, medical oncologists, and neuron-oncologists, and as an overview for physicians in training.
The current explosion of new areas of controversy in the treatment of acute lymphocytic leukemia in adults and young adults makes this comprehensive book a much needed reference for hematologists and oncologists. This book assembles leading authorities from around the globe to cover the full spectrum of ALL subtypes and their treatments. Specific topics of discussion include indications for allogeneic bone marrow transplant in first complete remission, the role of minimal residual disease in making treatment decisions, the treatment of young adults, and the treatment of Philadelphia chromosome positive ALL with the advent of the tyrosine kinase inhibitors. This is the first book to focus exclusively on the adult ALL patient. It provides a complete overview of diagnosis, molecular pathogenesis, evaluation, and treatment for this important patient population.
A review of state-of-the-art therapies currently used with leptomeningeal cancer patients, including information on symptom management, new clinical trials, epidemiology, as well as research in animal models for experimental treatments.
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.
A succinct summary of the key principles and facts that guide the everyday practice of modern, clinical paediatric hematology. Covering all the information necessary for examinations in the topic, this book is ideal for postgraduates studying paediatric hematology, as well as for junior doctors in training.
Better therapy of acute leukemias depends ultimately on better understanding of the distinction between leukemic and normal progenitor cells. This hugely important new book describes the current knowledge of acute leukemia biology and discusses new classification systems that have arisen as a result of emerging insights into pathogenesis. Estey, Faderl and Kantarjian, who all work at the respected Anderson Cancer Center in Houston, Texas, USA, examine in detail advances in the treatment of particular types of acute leukemia. Their book also covers the management of acute leukemia in general as well as the development of new therapies. This book will be extremely useful to clinicians.