Childhood acute lymphoblastic leukemia (ALL) is the “poster child” for the story of success in treating cancer patients. Over the past five decades, this essentially uniformly fatal disease has been eradicated in 80% of young patients. Cures were realized only as a result of slow and painstaking work that involved investigators pursuing a series of studies using radiation therapy and drugs such as vincristine, prednisone, cyclophosphamide, anthracyclines, l-asparaginase, methotrexate, and 6-mercapto-purine. ALL in adults is less common and clearly has a different disease biology. For example, only 3% of childhood ALL cases are BCR-ABL positive, in contrast to 20–30% in adults; despite emulating the pediatric approach, the cure rate in this population is only half that of childhood ALL.
In this tome, we rely upon some of the world’s ALL experts to enlighten the reader in all facets on the continuing progress in the diagnosis and treatment of this disorder. The reader will receive in-depth updates ranging from the epidemiology and causation, to pathobiology including cytogenetic and specific gene abnormalities, to pharmacology and pharmacogenetics. Our contributors address new paradigms for classifying disease subsets as well as techniques for detecting and monitoring minimal residual disease and the implications thereof. Further, these extremely knowledgeable investigators present and discuss the many clinical and biologic factors that form the basis of risk assessment for the entire constellation of patient-, disease- and treatment-related factors for the various patient subsets. For example, they discuss the need for approaching adolescents and young adults differently than older adults. We review the different treatment strategies from remission induction, consolidation/intensification and maintenance, including the use of novel agents such as monoclonal antibodies, tyrosine kinase inhibitors, and agents that appear to have selectivity in specific T-cell and B-cell lineage. Finally, we address the pros and cons of hematopoietic stem cell transplantation as a therapeutic modality.
What is the future likely to hold for patients and investigators alike? We can look forward to continued progress in this uncommon but very important disorder that has stood as a model for the success of combination chemotherapy. Already monoclonal antibodies alone or in combination are in clinical trials and have shown great promise. The tyrosine kinase inhibitors, particularly the more potent SRCABL inhibitors, add significantly to chemotherapy effect. The introduction of a number of T-cell targeting agents (nelarabine) and “anti-ALL drugs” (clofarabine) already have been shown to improve patient outcome. Modified formulations of the older agents l-asparaginase (pegylated formulation), vincristine (liposomal formulation), and cytarabine (liposomal formulation for CNS disease) may provide enhanced efficacy as well. New NOTCH inhibitors are being developed that soon will enter the clinical arena. Finally, reduced-intensity conditioning transplantation procedures, especially with greater use of alternative donors such as umbilical cord blood grafts, may provide positive anti-ALL effect with significantly less toxicity. The future holds great promise and undoubtedly the cure rate in this malignant disorder will continue to increase.
- The Editors -
Contents
- Chapter 1 A Perspective on the Treatment of Acute Lymphoblastic Leukemia
- Chapter 2 Clinical Features and Making the Diagnosis
- Chapter 3 The Biology of Adult Acute Lymphoblastic Leukemia
- Chapter 4 Minimal Residual Disease in Acute Lymphoblastic Leukemia
- Chapter 5 Cytogenetics
- Chapter 6 Acute Lymphoblastic leukemia: Epidemiology
- Chapter 7 Prognostic Factors in Acute Lymphoblastic Leukemia
- Chapter 8 The Generalized Care of the Patient with Acute Lymphoblastic Leukemia
- Chapter 9 Treatment of Acute Lymphoblastic Leukemia in Middle-Age and Older Adults
- Chapter 10 Pharmacology of Acute Lymphoblastic Leukemia Therapy
- Chapter 11 Assessment of Response to Treatment
- Chapter 12 T-cell Acute Lymphoblastic Leukemia
- Chapter 13 Burkitt Leukemia and Lymphoma
- Chapter 14 Treatment of Acute Lymphoblastic Leukemia in Young Adults Nicolas Boissel Francoise Huguet Herve Dombret
- Chapter 15 Treatment of Philadephia Chromosome Positive Acute Lymphoblastic Leukemia
- Chapter 16 Molecular Therapies
- Chapter 17 Treatment of Relapsed/ Refractory Acute Lymphoblastic Leukemia
- Chapter 18 Allogenic Stem Cell Transplantation for Acute Lymphoblastic Leukemia in Adults
- Chapter 19 Hematopoietic Stem Cell Transplantation in Philadelphia-positive Acute Lymphoblastic Leukemia
- Chapter 20 Special Challenges: Genetic polymorphisms and therapy
- Chapter 21 Late Consequences of Therapy of Acute Lymphoblastic Leukemia
- Chapter 22 Immunotherapy for Acute Lymphocytic Leukemia
- Chapter 23 Unique Subtypes in Acute Lymphoblastic Leukemia
About the Editors
- Anjali S. Advani, MD, Cleveland Clinic, Taussig Cancer Center, Cleveland, OH, USA.
- Hillard M. Lazarus, MD, Case Western Reserve University, University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Cleveland, OH, USA.
Product Details
- Hardcover: 404 pages
- Publisher: Humana Press; 1st Edition (2011)
- Language: English
- ISBN-10: 1607617064
- ISBN-13: 978-1607617068
- Product Dimensions: 10.1 x 7.1 x 1.1 inches
List Price: $219.00