Acute Lymphoblastic Leukemia

4/04/00 (Brady)

Group: Tuesday Interns

RE: A 46 year old female with new onset facial numbness and weakness.

Question: What are the characteristics of ALL (Acute Lymphoblastic Leukemia)?

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Unique Identifier: 97178916

Authors: Laport GF. Larson RA.

Institution: Department of Medicine, Pritzker School of Medicine, University of Chicago, IL 60637, USA.

Abstract: Acute lymphoblastic leukemia (ALL) has served as a model for the cure of neoplasia by chemotherapy. Current: treatment results in complete remissions in 80% to 90% of cases with long-term survival of 30% to 40%. Mature B cell and: T cell ALL cases that previously had a poor prognosis are now viewed as favorable subgroups. Treatment regimens have: evolved empirically into complex schemes, although few of the individual components have been rigorously tested in: randomized trials. Maintenance therapy is a standard component of pediatric ALL, but its benefit has not been completely: established in adults, although two trials which omitted maintenance are notable for short disease-free survival. Optimal: consolidation and intensification therapy remains controversial with numerous trials suggesting benefit, but several: randomized trials fail to confirm improved disease-free survival. Central nervous system prophylaxis is an integral step in: treatment. Identification of subtypes of ALL with different prognosis and treatment requirements offers the potential to: improve management and survival in ALL. [References: 65]

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Unique Identifier: 97056508

Authors: Bassan R. Lerede T. Barbui T.

Institution: Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy.

Abstract: Bone marrow recurrence of adult acute lymphoblastic leukemia is typically an aggressive and most often rapidly fatal: condition, an ideal setting for testing the latest research developments and experimental therapeutic options. Here we: review recurrence mechanisms and treatment possibilities in order to identify the most appropriate clinical conduct. Choice: of retreatment drugs and their dosages, related or unrelated donor bone marrow transplants, autologous peripheral blood: stem cell transplants, immune manipulations, reversal of drug resistance, and restoration of apoptosis are all part of an: integrated short-term therapeutic and decisional network to be developed for specific patient and disease prognostic: subgroups. [References: 172]

Link Directly to Fulltext Article at Publisher

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Unique Identifier: 96210967

Authors: Gokbuget N. Hoelzer D.

Institution: University Clinics Frankfurt, Department of Internal Medicine, Germany.

Abstract: The application of high-dose treatment elements has an increasing importance in the therapy of acute lymphoblastic: leukemia (ALL). High-dose methotrexate (HDMTX) has been introduced in clinical trials more than 20 years ago, since it: has several theoretical advantages compared to conventional dose methotrexate. These trials revealed that the efficacy and: toxicity of HDMTX depends on features such as dose level, infusion time, combination regimen and schedule of leucovorin: rescue. Particularly the application of controlled leucovorin rescue and improved supportive care enabled the application of: increasing doses of HDMTX in the treatment of childhood and adult ALL within a variety of schedules and at dose levels: mostly ranging between 0.5 g/m2 and 5.0 g/m2. In childhood ALL, first devised to replace CNS irradiation in the: prophylaxis of CNS relapse HDMTX has contributed to the reduction of bone marrow relapses particularly in low risk: B-lineage ALL. In addition it proved to be an effective therapy element for prophylaxis and treatment of CNS disease. At: least in low risk ALL CNS irradiation could be safely replaced by repeated cycles of HDMTX with additional intrathecal: therapy. In adult ALL only few of the successful treatment approaches with HDMTX have been investigated up to now.: The results indicate that HDMTX has a beneficial effect with regard to overall outcome in adult B-lineage ALL. It provides: effective CNS prophylaxis in combination with intrathecal therapy. In mature B-ALL HDMTX proved to be one of the: most effective treatment elements and contributed to an impressive improvement of outcome in this subgroup. For T-ALL: however sufficient data do not exist either in childhood or in adult ALL. Since HDMTX is an effective treatment element: with manageable acute and long-term toxicity, its role in the management of adult ALL should be explored more: intensively. [References: 58]