Management of CNS Disease in Pediatric Acute Lymphoblastic Leukemia
Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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Management of CNS Disease in Pediatric Acute Lymphoblastic Leukemia. / McNeer, Jennifer L.; Schmiegelow, Kjeld.
I: Current Hematologic Malignancy Reports, Bind 17, Nr. 1, 2022, s. 1-14.Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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TY - JOUR
T1 - Management of CNS Disease in Pediatric Acute Lymphoblastic Leukemia
AU - McNeer, Jennifer L.
AU - Schmiegelow, Kjeld
PY - 2022
Y1 - 2022
N2 - Purpose of Review The treatment of acute lymphoblastic leukemia (ALL) is one of the success stories of pediatric oncology, but challenges and questions remain, including the optimal approach to the treatment of central nervous system (CNS) leukemia. It is unclear why some children with ALL develop CNS leukemia and others do not, and there remains debate regarding optimal regimens for prophylaxis, upfront treatment, and the treatment of CNS relapses. These topics are especially important since both cranial radiation therapy (CRT) and intensive intrathecal therapy carry risks of both short- and long-term adverse effects. In this review, we aim to identify areas of ongoing debate on this topic, review the biology of CNS leukemia, and summarize clinical trial data that address some of these questions. Recent Findings Both retrospective and meta-analyses have demonstrated that few patients with ALL benefit from CRT as a component of CNS-directed treatment for de novo disease, allowing cooperative groups to greatly limit the number of patients undergoing CRT as part of their initial ALL regimens. More recent efforts are focusing on how best to assay for low levels of CNS disease at the time of diagnosis, as well as the biological drivers that may result in CNS leukemia in certain patients. Progress remains to be made in the identification and treatment of CNS leukemia in pediatric ALL. Advancements have occurred to limit the number of children undergoing CRT, but much has yet to be learned to better understand the biology of and risk factors for CNS leukemia, and novel approaches are required to approach CNS relapse of ALL.
AB - Purpose of Review The treatment of acute lymphoblastic leukemia (ALL) is one of the success stories of pediatric oncology, but challenges and questions remain, including the optimal approach to the treatment of central nervous system (CNS) leukemia. It is unclear why some children with ALL develop CNS leukemia and others do not, and there remains debate regarding optimal regimens for prophylaxis, upfront treatment, and the treatment of CNS relapses. These topics are especially important since both cranial radiation therapy (CRT) and intensive intrathecal therapy carry risks of both short- and long-term adverse effects. In this review, we aim to identify areas of ongoing debate on this topic, review the biology of CNS leukemia, and summarize clinical trial data that address some of these questions. Recent Findings Both retrospective and meta-analyses have demonstrated that few patients with ALL benefit from CRT as a component of CNS-directed treatment for de novo disease, allowing cooperative groups to greatly limit the number of patients undergoing CRT as part of their initial ALL regimens. More recent efforts are focusing on how best to assay for low levels of CNS disease at the time of diagnosis, as well as the biological drivers that may result in CNS leukemia in certain patients. Progress remains to be made in the identification and treatment of CNS leukemia in pediatric ALL. Advancements have occurred to limit the number of children undergoing CRT, but much has yet to be learned to better understand the biology of and risk factors for CNS leukemia, and novel approaches are required to approach CNS relapse of ALL.
KW - Pediatric acute lymphoblastic leukemia
KW - Central nervous system leukemia
KW - Cranial radiation therapy
KW - Intrathecal chemotherapy
KW - NERVOUS-SYSTEM INVOLVEMENT
KW - INTRATHECAL LIPOSOMAL CYTARABINE
KW - TRAUMATIC LUMBAR PUNCTURE
KW - LOW LEUKOCYTE COUNTS
KW - CEREBROSPINAL-FLUID
KW - CANCER-INSTITUTE
KW - RECURRENT CNS
KW - CHILDREN
KW - CHILDHOOD
KW - RISK
U2 - 10.1007/s11899-021-00640-6
DO - 10.1007/s11899-021-00640-6
M3 - Review
C2 - 35025035
VL - 17
SP - 1
EP - 14
JO - Current Hematologic Malignancy Reports
JF - Current Hematologic Malignancy Reports
SN - 1558-8211
IS - 1
ER -
ID: 325671896