Optimized treatment of childhood B-lineage acute lymphoblastic leukemia
ZHU Xiao-Fan
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin 300020, China (Email: xfzhu@ihcams.ac.cn)
Abstract Childhood acute lymphoblastic leukemia (ALL) accounts for about 75% of childhood leukemia cases, and B-lineage acute lymphoblastic leukemia (B-ALL) accounts for more than 80% of childhood ALL cases. Over the past half century, new molecular biological targets discovered by new techniques have been used in precise stratification of disease prognosis, and there has been a gradual increase in the 5-year overall survival rate of childhood ALL. With the increasing attention to long-term quality of life, the treatment of childhood B-ALL has been constantly optimized from induction therapy to the intensity of maintenance therapy, including the treatment of extramedullary leukemia without radiotherapy, which has been tried with successful results. The realization of optimized treatment also benefits from the development of new techniques associated with immunology and molecular biology and the establishment of standardized clinical cohorts and corresponding biobanks. This article summarizes the relevant research on the implementation of precise stratification and the intensity reduction and optimization treatment of B-ALL in recent years, providing reference for clinicians. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(4): 344-349
Li XY, Li JQ, Luo XQ, et al. Reduced intensity of early intensification does not increase the risk of relapse in children with standard risk acute lymphoblastic leukemia—a multi-centric clinical study of GD-2008-ALL protocol[J]. BMC Cancer, 2021, 21(1): 59. PMID: 33435902. PMCID: PMC7805214. DOI: 10.1186/s12885-020-07752-x.
Tran TH, Hunger SP. The genomic landscape of pediatric acute lymphoblastic leukemia and precision medicine opportunities[J]. Semin Cancer Biol, 2022, 84: 144-152. PMID: 33197607. DOI: 10.1016/j.semcancer.2020.10.013.
Tanaka K, Kato I, Dobashi Y, et al. The first Japanese biobank of patient-derived pediatric acute lymphoblastic leukemia xenograft models[J]. Cancer Sci, 2022, 113(11): 3814-3825. PMID: 35879192. PMCID: PMC9633318. DOI: 10.1111/cas.15506.
Zhang Y, Wang S, Zhang J, et al. Elucidating minimal residual disease of paediatric B-cell acute lymphoblastic leukaemia by single-cell analysis[J]. Nat Cell Biol, 2022, 24(2): 242-252. PMID: 35145224. DOI: 10.1038/s41556-021-00814-7.
Mehtonen J, Teppo S, Lahnalampi M, et al. Single cell characterization of B-lymphoid differentiation and leukemic cell states during chemotherapy in ETV6-RUNX1-positive pediatric leukemia identifies drug-targetable transcription factor activities[J]. Genome Med, 2020, 12(1): 99. PMID: 33218352. PMCID: PMC7679990. DOI: 10.1186/s13073-020-00799-2.
Bartram J, Patel B, Fielding AK. Monitoring MRD in ALL: methodologies, technical aspects and optimal time points for measurement[J]. Semin Hematol, 2020, 57(3): 142-148. PMID: 33256904. DOI: 10.1053/j.seminhematol.2020.06.003.
Angiolillo AL, Schore RJ, Kairalla JA, et al. Excellent outcomes with reduced frequency of vincristine and dexamethasone pulses in standard-risk B-lymphoblastic leukemia: results from Children's Oncology Group AALL0932[J]. J Clin Oncol, 2021, 39(13): 1437-1447. PMID: 33411585. PMCID: PMC8274746. DOI: 10.1200/JCO.20.00494.
Shen S, Chen X, Cai J, et al. Effect of dasatinib vs imatinib in the treatment of pediatric philadelphia chromosome-positive acute lymphoblastic leukemia: a randomized clinical trial[J]. JAMA Oncol, 2020, 6(3): 358-366. PMID: 31944221. PMCID: PMC6990720. DOI: 10.1001/jamaoncol.2019.5868.
Yang W, Cai J, Shen S, et al. Pulse therapy with vincristine and dexamethasone for childhood acute lymphoblastic leukaemia (CCCG-ALL-2015): an open-label, multicentre, randomised, phase 3, non-inferiority trial[J]. Lancet Oncol, 2021, 22(9): 1322-1332. PMID: 34329606. PMCID: PMC8416799. DOI: 10.1016/S1470-2045(21)00328-4.
Zhuang Y, Wu K, Zhu X, et al. Reduced dose intensity of daunorubicin during remission induction for low-risk patients with acute lymphoblastic leukemia: a retrospective cohort study of the Chinese Children's Cancer Group[J]. Front Oncol, 2022, 12: 911567. PMID: 35747795. PMCID: PMC9209708. DOI: 10.3389/fonc.2022.911567.
Wan Y, Zhang H, Zhang L, et al. Extended vincristine and dexamethasone pulse therapy may not be necessary for children with TCF3-PBX1 positive acute lymphoblastic leukaemia[J]. Br J Haematol, 2022, 199(4): 587-596. PMID: 36114009. PMCID: PMC9649883. DOI: 10.1111/bjh.18437.
Yeh TC, Liang DC, Hou JY, et al. Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation: results of the TPOG-ALL-2002 study[J]. Cancer, 2018, 124(23): 4538-4547. PMID: 30303520. DOI: 10.1002/cncr.31758.
Nguyen HTK, Terao MA, Green DM, et al. Testicular involvement of acute lymphoblastic leukemia in children and adolescents: diagnosis, biology, and management[J]. Cancer, 2021, 127(17): 3067-3081. PMID: 34031876. PMCID: PMC9677247. DOI: 10.1002/cncr.33609.
Chen X, Wang Y, Ruan M, et al. Treatment of testicular relapse of B-cell acute lymphoblastic leukemia with CD19-specific chimeric antigen receptor T cells[J]. Clin Lymphoma Myeloma Leuk, 2020, 20(6): 366-370. PMID: 32205078. PMCID: PMC8312220. DOI: 10.1016/j.clml.2019.10.016.
