MANAGEMENT OF PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA

Abstract

The lecture presents modern data on acute lymphoblastic leukemia as the one of the most common malignant disease of children, youth and the elderly. The data on the major risk factors, causes, pathogenesis, clinical manifestations, as well as the main approaches to the diagnosis and treatment of this disease and possible predictions for patients in different clinical situations are described.

Patients with ALL are usually immuno-compromised. There are 2 reasons for this: the lack of healthy WBCs and many of the medicines used to treat ALL can weaken the immune system. Other commonly observed complications include pancytopenia, febrile neutropenia, tumor lysis syndrome, chemotherapy related GI toxicity, treatment-related alopecia, leukostasis, ocular involvement, chemotherapy-related CNS toxicity, avascular necrosis, anthracycline-related cardiotoxicity, vincristine-related neuropathy, bleeding (intracranial, pulmonary, GI hemorrhage), infertility. PROGNOSISAcute lymphoblastic leukemia is a curable disease, and the chance of cure for a specific patient depends on a number of prognostic factors (females tend to fare better than males; Caucasians are more likely to develop acute leukemia than African-Americans, Asians, or Hispanics; children 1–10 years of age are most likely to develop ALL and to be cured of it; cases in older patients are more likely to result from chromosomal abnormalities, etc. Outcome is heavily age dependent in adult ALL. For the age groups under 30 years, 30–60 years, and over 60 years, complete remission rates are 90 %, 81 % and 52 % and overall survival at 3 years is 58 %, 38 %, and 12 % respectively [2, 6]. The 5-year survival rate has improved from zero six decades ago, to 85 % currently, largely because of clinical trials on new chemotherapeutic agents and improvements in SCT technology. An individual’s risk depends on a variety of clinical and biological factors. Negative prognostic features include older age, elevated WBC at presentation above 100×109/L, failure to achieve complete remission within 4 weeks of treatment, adverse cytogenetic and immunophenotype abnormalities. Younger patients with WBC less than 30×109/L and who respond to treatment within 4 weeks have the best prognosis.