Childhood Leukemia

Stephen P. Hunger, David T. Teachey, Stephan Grupp, Richard Aplenc

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

7 Scopus citations

Abstract

Leukemia is the most common cancer in children and adolescents, comprising 30% of malignancies that occur before age 15 and 25% that occur before age 20. Unlike adult leukemia, almost all pediatric leukemias are acute, meaning that they are derived from primitive blast cells. Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) together account for almost 95% of pediatric leukemias, with ALL being more common than AML throughout childhood. Other childhood leukemias include juvenile myelomonocytic leukemia, a rare leukemia that almost always occurs before age 5, myelodysplastic syndromes that are largely unique to childhood, and chronic myeloid leukemia that is highly similar to the adult disease. Event-free survival rates now exceed 85% for ALL and 50% for AML and overall survival rates exceed 90% and 60%. ALL is treated with 6-8 months of modestly intensive, but non-myeloablative therapy followed by prolonged low intensity maintenance therapy. In contrast, AML is treated with 4-5 cycles of intensive myelotoxic therapy with each cycle producing 2-4 weeks of profound neutropenia. Allogeneic hematopoietic stem cell transplantation is used much more frequently in first remission for AML a compared to ALL, but is a cornerstone of treatment of relapsed ALL or AML. Distinct biological subtypes of ALL and AML have been defined based upon recurrent sentinel genomic alterations, especially those that create fusion proteins. Emerging trends in therapy include the use of precision medicine treatments and the use of new immunotherapies including chimeric antigen receptor modified T-cells.

Original languageEnglish
Title of host publicationAbeloff’s Clinical Oncology
PublisherElsevier
Pages1748-1764.e4
ISBN (Electronic)9780323476744
DOIs
StatePublished - 1 Jan 2019
Externally publishedYes

Keywords

  • Acute lymphoblastic leukemia
  • Acute myeloid leukemia
  • Chronic myeloid leukemia
  • Juvenile myelomonocytic leukemia
  • Myelodysplastic syndrome

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