{"title":"Paediatric Acute Lymphoblastic Leukaemia: A Narrative Review of Current Knowledge and Advancements.","authors":"Sarah Elgazar, Constantina Constantinou","doi":"10.1007/s11912-024-01608-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to provide an update on current knowledge regarding paediatric acute lymphoblastic leukaemia (ALL), focusing on recent advancements in diagnosis and treatment, as well as future directions in the field.</p><p><strong>Recent findings: </strong>ALL is the most frequently diagnosed paediatric malignancy, with advances leading to a 90% survival rate. The heterogeneity of childhood ALL requires a precise diagnostic algorithm incorporating morphological, immunophenotypic, and cytogenetic analyses. Research is exploring next-generation sequencing and artificial intelligence-aided techniques for future diagnostic approaches. Despite these advancements, global disparities in healthcare access hinder prompt diagnosis and management. The pathophysiology of ALL involves chromosomal and genetic alterations which disrupt cell-cycle regulation and result in uncontrolled lymphoblast proliferation. Environmental factors also contribute to leukaemogenesis. Risk-stratification based on genetic subtypes has significant implications for risk-based therapy. Chemotherapy is administered in three phases: induction, consolidation, and maintenance, with prophylactic intrathecal chemotherapy considered essential. For high-risk, refractory, or relapsed ALL, haematopoietic stem cell transplantation and novel therapies such as tyrosine kinase inhibitors, chimeric antigen receptor T-cell therapy, and blinatumomab immunotherapy, have improved outcomes. Ongoing clinical trials aim to further improve treatment efficacy, reduce toxicity, and increase survival. Although prevention strategies for ALL exist at three levels, the supporting evidence remains limited, highlighting a need for further research. Continued research and clinical trials are essential to addressing the gaps treatment efficacy and prevention strategies. Efforts to improve global healthcare access and integrate novel diagnostic and therapeutic approaches are crucial for advancing outcomes for paediatric patients with ALL.</p>","PeriodicalId":10861,"journal":{"name":"Current Oncology Reports","volume":null,"pages":null},"PeriodicalIF":4.7000,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Oncology Reports","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11912-024-01608-4","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose of review: This review aims to provide an update on current knowledge regarding paediatric acute lymphoblastic leukaemia (ALL), focusing on recent advancements in diagnosis and treatment, as well as future directions in the field.
Recent findings: ALL is the most frequently diagnosed paediatric malignancy, with advances leading to a 90% survival rate. The heterogeneity of childhood ALL requires a precise diagnostic algorithm incorporating morphological, immunophenotypic, and cytogenetic analyses. Research is exploring next-generation sequencing and artificial intelligence-aided techniques for future diagnostic approaches. Despite these advancements, global disparities in healthcare access hinder prompt diagnosis and management. The pathophysiology of ALL involves chromosomal and genetic alterations which disrupt cell-cycle regulation and result in uncontrolled lymphoblast proliferation. Environmental factors also contribute to leukaemogenesis. Risk-stratification based on genetic subtypes has significant implications for risk-based therapy. Chemotherapy is administered in three phases: induction, consolidation, and maintenance, with prophylactic intrathecal chemotherapy considered essential. For high-risk, refractory, or relapsed ALL, haematopoietic stem cell transplantation and novel therapies such as tyrosine kinase inhibitors, chimeric antigen receptor T-cell therapy, and blinatumomab immunotherapy, have improved outcomes. Ongoing clinical trials aim to further improve treatment efficacy, reduce toxicity, and increase survival. Although prevention strategies for ALL exist at three levels, the supporting evidence remains limited, highlighting a need for further research. Continued research and clinical trials are essential to addressing the gaps treatment efficacy and prevention strategies. Efforts to improve global healthcare access and integrate novel diagnostic and therapeutic approaches are crucial for advancing outcomes for paediatric patients with ALL.
综述目的:本综述旨在提供有关儿科急性淋巴细胞白血病(ALL)的最新知识,重点关注诊断和治疗方面的最新进展以及该领域的未来发展方向:儿童急性淋巴细胞白血病是最常见的儿科恶性肿瘤,随着治疗技术的不断进步,其存活率高达 90%。儿童 ALL 的异质性需要结合形态学、免疫表型和细胞遗传学分析的精确诊断算法。研究人员正在为未来的诊断方法探索下一代测序和人工智能辅助技术。尽管取得了这些进步,但全球医疗服务的不均衡阻碍了及时诊断和管理。ALL 的病理生理学涉及染色体和基因的改变,这些改变破坏了细胞周期的调节,导致淋巴细胞增殖失控。环境因素也会导致白血病的发生。根据基因亚型进行风险分级对基于风险的治疗具有重要意义。化疗分为三个阶段:诱导、巩固和维持,预防性鞘内化疗被认为是必不可少的。对于高危、难治或复发的 ALL,造血干细胞移植和新型疗法(如酪氨酸激酶抑制剂、嵌合抗原受体 T 细胞疗法和 blinatumomab 免疫疗法)可改善治疗效果。目前正在进行的临床试验旨在进一步提高疗效、减少毒性和提高存活率。虽然在三个层面上都有针对 ALL 的预防策略,但支持性证据仍然有限,这凸显了进一步研究的必要性。持续的研究和临床试验对于缩小治疗效果和预防策略的差距至关重要。努力改善全球医疗服务的可及性并整合新型诊断和治疗方法,对于提高儿童 ALL 患者的治疗效果至关重要。
期刊介绍:
This journal aims to review the most important, recently published clinical findings in the field of oncology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care of those affected by cancer.
We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as cancer prevention, leukemia, melanoma, neuro-oncology, and palliative medicine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.