Management of CNS Disease in Pediatric Acute Lymphoblastic Leukemia.

Autor: McNeer JL; Section of Pediatric Hematology/Oncology/Stem Cell Transplant, University of Chicago Comer Children's Hospital, 5841 S. Maryland Ave, MC 4060, Chicago, IL, 60637, USA. jmcneer@peds.bsd.uchicago.edu., Schmiegelow K; Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: Current hematologic malignancy reports [Curr Hematol Malig Rep] 2022 Feb; Vol. 17 (1), pp. 1-14. Date of Electronic Publication: 2022 Jan 13.
DOI: 10.1007/s11899-021-00640-6
Abstrakt: Purpose of Review: The treatment of acute lymphoblastic leukemia (ALL) is one of the success stories of pediatric oncology, but challenges and questions remain, including the optimal approach to the treatment of central nervous system (CNS) leukemia. It is unclear why some children with ALL develop CNS leukemia and others do not, and there remains debate regarding optimal regimens for prophylaxis, upfront treatment, and the treatment of CNS relapses. These topics are especially important since both cranial radiation therapy (CRT) and intensive intrathecal therapy carry risks of both short- and long-term adverse effects. In this review, we aim to identify areas of ongoing debate on this topic, review the biology of CNS leukemia, and summarize clinical trial data that address some of these questions.
Recent Findings: Both retrospective and meta-analyses have demonstrated that few patients with ALL benefit from CRT as a component of CNS-directed treatment for de novo disease, allowing cooperative groups to greatly limit the number of patients undergoing CRT as part of their initial ALL regimens. More recent efforts are focusing on how best to assay for low levels of CNS disease at the time of diagnosis, as well as the biological drivers that may result in CNS leukemia in certain patients. Progress remains to be made in the identification and treatment of CNS leukemia in pediatric ALL. Advancements have occurred to limit the number of children undergoing CRT, but much has yet to be learned to better understand the biology of and risk factors for CNS leukemia, and novel approaches are required to approach CNS relapse of ALL.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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