Acute Lymphoblastic Leukemia A Clinical Study

This book provides a comprehensive and up-to-date review of all aspects of childhood Acute Lymphoblastic Leukemia, from basic biology to supportive care. It offers new insights into the genetic pre-disposition to the condition and discusses how response to early therapy and its basic biology are utilized to develop new prognostic stratification systems and target therapy. Readers will learn about current treatment and outcomes, such as immunotherapy and targeted therapy approaches. Supportive care and management of the condition in resource poor countries are also discussed in detail. This is an indispensable guide for research and laboratory scientists, pediatric hematologists as well as specialist nurses involved in the care of childhood leukemia.

In Treatment of Acute Leukemias, international experts not only review the state-of-the-art in managing children and adults with acute leukemia, but also debate the pros and cons of current controversial and problematic issues. The book summarizes the best diagnostic and treatment practices for acute leukemias in children, adolescents, and adults. Among the therapies discussed are methotrexate, asparaginase, antipurines, epipodophyllotoxins, hematopoietic stem cell transplantation, hematopoietic growth factors, and immunotherapy.

This book provides a state-of-the-art overview of acute lymphoblastic leukemia (ALL). The first section of the book presents the translational science behind ALL, reviewing molecular pathways and targets in B- and T-cell ALL, as well as techniques and application of minimal residual disease testing. The second section spotlights ALL management strategies for patients across the spectrum, from infants to the elderly. The final section outlines current and new advances in ALL treatment, including new monoclonal antibodies and allogenic and autologous HSCT. Written by experts in the field, Clinical Management of Acute Lymphoblastic Leukemia: From Bench to Bedside is a valuable resource that will guide patient management, stimulate investigative efforts, and increase understanding of the biologic underpinnings of the disease.

Scientific and Ethical Discipline in Clinical Trials on Acute Leukemia G. MATHE Institut de Cancerologie ct d'Immunogenetique "', Hi'ipital Paul-Brousse "."", Villejuif/France Clinical research is still in an evolutionary stage. Although scientific technology was readily accepted and applied, scientific methodology has been accepted much more slowly and is very rarely properly applied. There are three reasons why this is so. First, medical ethics frequently limits the applicability of clinical research, for doctors have to be more than scientists. They must also remain moral philosophers, as they were before medicine became a science. Second, the heterogeneity of the material on which clinical researchers work in studying human diseases makes the application of scientific methodology difficult. Third, researchers must publish. This means that they must obtain publishable results, and too often this means results in accordance with established concepts, easily accepted by the editors of established journals, which are read by the establishment. It is the privilege of too many people to be able to accept "truth" and recipes from other people and confirm their truth and results. It is the mission of a very few others to accept nothing as "truth" and to consider no recipe ideal, either in concept or detail.

The majority of cancers present at a relatively advanced stage in which invasion within the primary organ is well established and metastases to lymph and distant organs are either clinically apparent or present at the microscopic level. However, it is increasingly recognized that the natural history of cancer formation is a long and complex path taking many years to develop to a clinically apparent stage in most cases. Furthermore, for most solid tumours there is a pre-invasive or intraepithelial stage of disease. This affords the opportunity for early detection and prevention of invasive disease and hence a cure. However, with this advancing knowledge comes a whole plethora of questions which will be explored in this monograph. Firstly, we need to understand the global burden of pre-invasive disease and what the public health implications might be for wide-scale screening programmes. In the western world we already have experience of screening for cervical, breast, prostate and more recently colon cancer. As well as their potential benefits these programmes have financial and psychosocial implications which need to be carefully weighed. This is especially true since many pre-invasive lesions will not progress to cancer in a individual’s lifetime. In addition, there are questions concerning whether screening reduces the cancer burden or in fact distorts the survival figures through lead-time bias. Secondly, at the level of epidemiology and molecular pathogenesis there are important questions regarding the aetiology of pre-invasive lesions; an understanding of which might lead to possible chemopreventive strategies. For example, it would be helpful to know the extent to which the likelihood of developing a pre-invasive lesion is influenced by lifestyle or genetic factors and how these factors influence the risk of progression to invasive disease. At the molecular level we need to understand the pathways and molecular mechanisms, both genetic and epigenetic, by which cells achieve the capacity to invade. Thirdly, in order make clinical progress we need biomarkers to identify and risk stratify individuals with pre-invasive lesions. These biomarkers might be applied to the serum as in Prostate Specific Antigen in prostate cancer or be applied to tissue samples, such as oestrogen receptor status in breast cancer. In order to utilize biomarkers in the context of a screening programme there are issue around the invasiveness of the test as well as its positive and negative predictive value. With advances in molecular imaging there is now the exciting possibility of incorporating a molecular tag to a non-invasive imaging modality. Fourthly, in order to justify screening early detection must be coupled to a treatment strategy. If the chemopreventive agent is very well tolerated, then as well as targeting high risk groups, one might consider treatment at the population level. Aspirin is one such drug which has been extensively assessed in the context of colon cancer chemoprevention trials. Trials of aspirin chemoprevention are now being applied to other cancers such as oesophageal adenocarcinoma and since many individuals take aspirin for .chemoprevention of cardiovascular disease the cancer incidence can be ascertained in these populations. In order to understand the more general issues raised from the discussions above it is useful to consider disease specific examples. Our understanding of pre-invasive disease varies according to the organ site and there are lessons to be learned from these experiences. For example, there is now the prospect of a vaccine for cervical cancer with important questions about how this might be applied to the high incidence areas of the developing world. On the other hand, ductal carcinoma in situ is currently treated by mastectomy which is more radical than the treatment received by many women with invasive disease. Oesophageal adenocarcinoma, which is my own area of expertise is interesting because of the rapid rise in incidence in the western world and the clinically accessible pre-invasive lesion called Barrett’s oesophagus. However, most cases of Barrett’s oesophagus remain undiagnosed and it is not yet clear how to effectively diagnose, monitor and treat this condition without recourse to mass endoscopy with substantial cost implications. In conclusion, in an era in which preventive medicine is a major concern for consumers, health-policy makers and politicians pre-invasive disease is likely to become a major part of cancer medicine.

This book discusses key aspects of childhood acute lymphoblastic leukemia (ALL), presenting the latest research on the biology and treatment of the disease and related issues. The cure rate for ALL has improved dramatically due to advances such as supportive care, treatment stratification based on relapse risk, and the optimization of treatment regimens. Gathering contributions by eminent scholars Pediatric Acute Lymphoblastic Leukemia is a valuable resource for pediatric hematologists as well as for medical students, interns, residents and fellows. It not only offers comprehensive insights, but also provides a springboard for future research.

This book provides an overview of the key developments in both acute lymphocytic leukemia and acute myeloid leukemia with a comprehensive guide to the epidemiology, pathogenesis, etiology, clinical manifestations, classification, diagnosis, and staging as well as the most recent developments in the therapeutic landscape for acute leukemia. The Handbook of Acute Leukemia offers readers a key resource into the future outlook for patients with leukemia and is edited and authored by internationally renowned experts in the field. Leukemia is cancer of the white blood cells and acute leukemia means the condition progresses rapidly and aggressively, requiring immediate treatment. Acute leukemia is classified according to the type of white blood cells that are affected: either lymphocytes and myeloid cells.

This book describes different perspectives of childhood acute lymphoblastic leukemia. The approach includes aspects of molecular epidemiology, particularly molecular features that influence the genesis and prognosis of the disease. Some aspects of the prognosis of lymphoblastic leukemias are very detailed, highlighting the use of molecular biology in the early identification of complications that may occur in diseased patients. The authors of the present book conform a Mexican group who identifies the causes of leukemia, and they summarize their experience in research, results and proposals for future studies. A causal model is included in which the authors hypothesized the origin of acute lymphoblastic leukemias, particularly in children. This hypothesis can be useful to better understand other cancers during childhood. This book will help the reader to identify different molecular aspects involved in leukemia, and its relation to the development and evolution of the disease.