Advances in the Diagnosis and Treatment of Pediatric Acute Lymphoblastic Leukemia

作者：Hiroto Inaba, Ching‐Hon Pui · 发表于：Journal of Clinical Medicine · 年份：2021 · DOI：10.3390/jcm10091926 · 被引用次数：241 · 研究领域：Acute Lymphoblastic Leukemia research、Childhood Cancer Survivors' Quality of Life、Hematopoietic Stem Cell Transplantation

The outcomes of pediatric acute lymphoblastic leukemia (ALL) have improved remarkably during the last five decades. Such improvements were made possible by the incorporation of new diagnostic technologies, the effective administration of conventional chemotherapeutic agents, and the provision of better supportive care. With the 5-year survival rates now exceeding 90% in high-income countries, the goal for the next decade is to improve survival further toward 100% and to minimize treatment-related adverse effects. Based on genome-wide analyses, especially RNA-sequencing analyses, ALL can be classified into more than 20 B-lineage subtypes and more than 10 T-lineage subtypes with prognostic and therapeutic implications. Response to treatment is another critical prognostic factor, and detailed analysis of minimal residual disease can detect levels as low as one ALL cell among 1 million total cells. Such detailed analysis can facilitate the rational use of molecular targeted therapy and immunotherapy, which have emerged as new treatment strategies that can replace or reduce the use of conventional chemotherapy.