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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Clinical risk assignment and suggested therapies in childhood acute lymphoblastic leukemia

Clinical risk assignment and suggested therapies in childhood acute lymphoblastic leukemia
Risk group Features Percent Recommended therapy Projected five-year event-free survival
Low

ALL of the following:

  1. NCI standard risk group*

  2. Lesser risk cytogenetics:
    Trisomies 4 and 10
    or
    ETV-RUNX1 (United States)
    or
    Hyperdiploid (Europe)

  3. Rapid response to therapy

15% Conventional antimetabolite-based therapy >95%
Average

EITHER of the following:

  1. NCI standard risk group*
    and
    Rapid response to therapy

  2. NCI standard risk group*
    and
    Lesser risk cytogenetics
    and
    Slow response to therapyΔ

36% Intensified antimetabolite therapy 90 to 95%
High

ANY of the following:

  1. NCI high risk group
    and
    Rapid response to therapy

  2. NCI standard risk group*
    and
    Slow response to therapyħ

  3. CNS-positive leukemia

  4. Testicular leukemia

25% Intensive multiagent chemotherapy 88 to 90%
Very high

ANY of the following:

  1. MRD+ at day 29§

  2. Induction failures

  3. MLL rearrangements
    or
    iAMP21 amplification

  4. Age <1 year (or >13 years if treated on a COG protocol)

24%

Consider allogeneic hematopoietic cell transplantation in first remission

Allogeneic transplant not recommended for infants

<80%
Special groups

T cell ALL

 

Intensive multiagent chemotherapy

66 to 80%[1,2]

 

Philadelphia chromosome
[t(9;22)]

   

Intensive multiagent chemotherapy containing a BCR-ABL tyrosine kinase inhibitor

 

70%[3]

WBC: white blood cell count; NCI: National Cancer Institute; MRD: measureable residual disease; CNS: central nervous system; MLL: mixed lineage leukemia gene; iAMP21: intrachromosomal amplification of chromosome 21; COG: Children's Oncology Group; ALL: acute lymphoblastic leukemia.
* NCI standard risk group: WBC <50,000/microL AND age one to <10 years.
¶ MRD negative at days 8 and 29 (rapid response to therapy).
Δ MRD positive at day 8 and negative at day 29 (slow response to therapy).
◊ NCI high risk group: WBC ≥50,000 microL OR age ≥10 years (up to 13 years if treated on a COG protocol).
§ With some exceptions.
References:
  1. Dunsmore KP, Devidas M, Linda SB, et al. Pilot study of nelarabine in combination with intensive chemotherapy in high-risk T-cell acute lymphoblastic leukemia: a report from the Children's Oncology Group. J Clin Oncol 2012; 30:2753.
  2. Asselin BL, Devidas M, Wang C, et al. Effectiveness of high-dose methotrexate in T-cell lymphoblastic leukemia and advanced-stage lymphoblastic lymphoma: a randomized study by the Children's Oncology Group (POG 9404). Blood 2011; 118:874.
  3. Schultz KR, Carroll A, Heerema NA, et al. Long-term follow-up of imatinib in pediatric Philadelphia chromosome-positive acute lymphoblastic leukemia: Children's Oncology group study AALL0031. Leukemia 2014; 28:1467.
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