Identifying patients at different risk of relapse in childhood acute lymphoblastic leukemia (ALL)

Martin Schrappe, MD, FRCP, from the University Medical Center Schleswig-Holstein, Kiel, Germany, discusses the AIEOP-BFM ALL 2000 (NCT01117441) trial, which used a new approach to identify patients at different levels of risk of relapse in childhood acute lymphoblastic leukemia (ALL) at the American Society of Hematology (ASH) Congress 2016 in San Diego, CA. He describes the identification of “standard risk” patients, while arguing that there is no standard risk leukemia, and that every leukemia is a fatal disease. However, Prof. Schrappe explains a large subset of patients can now be treated very successfully with current chemotherapy agents, and new technologies such as the detection of minimal residual disease (MRD) can be used to identify patients who can do well with less intensive treatment. Treatment was reduced in a randomized fashion in a later part of the therapy, but results showed that this is not possible as the late part of treatment is appears to be essential in preventing relapse. He recommends that the full treatment line should be given, but argues that in future in may be possible to decrease treatment at an early stage of treatment in patients at lower risk of relapse.

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