Acute Lymphoblastic Leukemia (All)

(Acute lymphoblastic leukemia)

Acute lymphoblastic leukemia (ALL) is the most common malignant disease in childhood. But they also affects adults of all ages. By malignant transformation and uncontrolled proliferation of abnormally differentiated, long-lived hematopoietic progenitor cell results in a high number of circulating blasts, to the displacement of the normal bone marrow by malignant cell clone and frequent infiltration of the central nervous system and abdominal organs. The clinical symptoms include fatigue, pallor, infection, bone pain and easy bruising and bleeding. By examining peripheral blood smears and bone marrow, the diagnosis can be mostly already made. Treatment typically consists of a chemotherapeutic in combination therapy to achieve remission, as well as intrathecal chemotherapy CNS prophylaxis, optionally in combination with an irradiation of the central nervous system for the prophylaxis or therapy of a CNS-infestation. To prevent recurrences, a consolidating therapy is used with or without stem cell transplantation or maintenance chemotherapy over a period of up to 3 years.

For an overview of acute leukemia, Overview: Acute leukemia.

Acute lymphoblastic leukemia (ALL) is the most common malignant disease in childhood. But they also affects adults of all ages. By malignant transformation and uncontrolled proliferation of abnormally differentiated, long-lived hematopoietic progenitor cell results in a high number of circulating blasts, to the displacement of the normal bone marrow by malignant cell clone and frequent infiltration of the central nervous system and abdominal organs. The clinical symptoms include fatigue, pallor, infection, bone pain and easy bruising and bleeding. By examining peripheral blood smears and bone marrow, the diagnosis can be mostly already made. Treatment typically consists of a chemotherapeutic in combination therapy to achieve remission, as well as intrathecal chemotherapy CNS prophylaxis, optionally in combination with an irradiation of the central nervous system for the prophylaxis or therapy of a CNS-infestation. To prevent recurrences, a consolidating therapy is used with or without stem cell transplantation or maintenance chemotherapy over a period of up to 3 years. For an overview of acute leukemia, Overview: Acute leukemia. Two thirds of total ALL cases occur in children, with the peak incidence between 2 and 5 years of age is. ALL is the most common malignant disease in childhood and the second leading cause of death in children <15 years. A second peak incidence of the disease occurs in adults over 45 years. Forecast To determine the therapeutic protocol and its intensity are prognostic factors helpful. Cheap prognostic factors include age 3-9 years leukocyte count <25,000 / ul (<50,000 / ul in children) FAB L1 morphology hyperploidy of leukemic cells with> 50 chromosomes and t (12; 21) No CNS involvement at diagnosis Unfavorable factors are karyotype of the leukemic cells with normal chromosome number, but abnormal chromosome morphology (pseudodiploid) the presence of the Philadelphia (Ph) chromosome t (9; 22) Advanced age in adult B-cell immunophenotype with the detection of superficial or cytoplasmic immunoglobulin early forerunner T cell phenotype; BCR-ABL similar molecular signature Whatever the prognostic factors, the probability of a first remission in children ? 95%, and in adults 70-90%. At least 75% of children achieve a continuously disease-free survival of 5 years and seem healed. 30-40% of adults have a continuously disease-free survival of 5 years. Imatinib improves the disease in adults and children with Ph-chromosome-positive ALL. Select Most study protocols patients with poor prognostic factors for treatment intensification, since the higher risk of treatment failure and ultimately death outweighs the higher treatment risks and toxicity of the therapy. Chemotherapy Sometimes stem cell transplantation or radiation therapy, the four main phases of ALL-treatment include remission induction CNS prophylaxis consolidation or intensification therapy maintenance treatment induction therapy The goal is to induce remission. Several treatment regimens are already using an early stage, an intensive chemotherapy. The reflectance can be obtained by the daily oral administration of prednisone and vincristine weekly i.v. be induced with the addition of either an anthracycline or asparaginase. Other drugs and combinations that are already being used at an early stage, are cytarabine and etoposide, and cyclophosphamide. In some protocols, medium- or high-dose comes i.v. Methotrexate with leucovorin rescue used. The adaptation of the drug combination and dosage in accordance with these risk factors. Drug treatment can by imatinib in Ph-chromosome-positive ALL supplemented werden.ZNS prophylaxis Often there is a leukemic infiltration of the meninges. Prophylaxis and therapy include intrathecal combined administration of methotrexate, cytarabine and corticosteroids or sole administration of methotrexate and cytarabine. A cranial nerves or whole brain radiation therapy may be necessary and is often used in patients with high risk of CNS involvement (z. B. at high Gesamtleukozytenwerten, high serum LDH, B-cell phenotype). Their use is however zurückgegangen.Konsolidierungstherapie aim of consolidating in recent years to prevent a recurrence. Consolidation therapy typically takes several months, combining drugs that have different mechanisms of action than the drug induction regimens. Allogeneic stem cell transplantation as consolidation therapy is in Philadelphia chromosome-positive ALL in adults or in the second or higher recurrence empfohlen.Erhaltungstherapie see Most protocols maintenance treatment with methotrexate and mercaptopurine before. The treatment time is usually 2½-3 years and may possibly in regimens that are initially more intense, be shorter. Clinical trials of monoclonal antibodies against the proteins on the cell surface of the leukocytes are underway, with some new agents seem promising. The therapy is usually short and intense with Burkitt’s leukemia, or ALL with mature B-cells (FAB-L3 morphology). In patients with a continuous complete remission for a period of one year the risk of recurrence is gering.Rezidive Leukemic cells can occur in bone marrow, central nervous system, testicles or other places again. A bone marrow involvement is almost always. Although a new chemotherapy in children in 80-90% of cases leads (30-40% in adults) to a second complete remission, this is usually short-lived. Chemotherapy few patients achieve bone marrow relapse a long-lasting disease-free second remission or cure. In the event that an HLA-identical family donor is available, a stem cell transplantation offers the best chance for a long-lasting remission or cure (hematopoietic stem cell transplantation). Cells from other relatives or matching, unrelated donors are also used. A transplant is rarely performed in patients> 65 years, because the chance of success is very low, the side effects, however, are often lethal. Is the central nervous system affected, treatment with intrathecal methotrexate is performed (with or without cytarabine or corticosteroids) twice a week until all clinical signs have disappeared. Due to the high probability of a systemic sowing of blasts, most regimens include systemic Reinduktionschemotherapie. The importance of continued intrathecal therapy and irradiation of the central nervous system in this situation is not yet clear. A relapse in the testes occurs either clinically by a firm, painless swelling in appearance or is detected by a biopsy. If clinical suspicion of a unilateral testicular infection and the apparently uninvolved testis should be biopsied yet. Just as the isolated CNS relapse is also in testicular relapse treatment in an irradiation of the affected testicle and additionally a systemic Reinduktionstherapie. Important points ALL is the most common cancer in children, but also comes in adults. The central nervous system is often affected; Most patients receive intrathecal chemotherapy and corticosteroids as well as occasionally CNS radiotherapy. The response to treatment is good, a cure is possible in about 75% of children and 30-40% of adults. A stem cell transplant may be helpful in relapse.

Health Life Media Team

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