Diagnostic and treatment advances of adults acute lymphoblastic leukemia
Journal Title: Postępy Nauk Medycznych - Year 2011, Vol 24, Issue 7
Abstract
Acute lymphoblastic leukemia (ALL) according the WHO 2008 classification is a type of precursor lymphoid neoplasms which is divided into leukemia/lymphoblastic lymphoma B type (75% ALL) and leukemia/lymphoblastic lymphoma T type (up to 25% of ALL cases). To establish diagnosis of ALL and differentiate it from lymphoma, over 20% infiltration with lymphoblasts in bone marrow is necessary. The adverse prognostic factors are t(9;22), t(4;11) and abnormal cytogenetics at the time of diagnosis. Treatment intensity of ALL is adjusted to patients age and different treatment protocols are used for older (> 55 years old) and younger patients. The same protocols are used for B or T lineage ALL. Treatment protocols consist of following phases: pretreatment, induction, consolidation and maintenance (2 years) or allotransplantation or autotransplantation. Prophylactic intrathecal administration of cytostatics during induction and consolidation is used for all patients. There are different treatment protocols for t(9;22) (PCR diagnosed as BCR-ABL by PCR) ALL patients. The combination of chemotherapy with tyrosine-kinase inhibitors and early allotransplantation is recommended for all BCR-ABL positive ALL patients. Other treatment modalities depend upon risk factors and status of minimal residual disease. Optimal supportive treatment is required in order to prolong overall survival (OS) in adult patients. Complete remission rates between 74 and 92% and 5 years OS of 37% were demonstrated after current treatment protocols.
Authors and Affiliations
Małgorzata Krawczyk-Kuliś, Sławomira Kyrcz-Krzemień
Keywords
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