Fever at diagnosis of pediatric acute lymphoblastic leukemia (ALL): Are antibiotics really necessary?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9553-9553
Author(s):  
Monica Khurana ◽  
James Henry Feusner ◽  
Brian Lee
Keyword(s):  
Medical Records ◽  
Bacterial Resistance ◽  
Lymphoblastic Leukemia ◽  
Coagulase Negative Staphylococcus ◽  
Inclusion Criteria ◽  
E Coli ◽  
Pediatric All ◽  
Patient’S History ◽  
Cancer Network ◽  
Related Mortality

9553 Background: Great variability exists in the management of suspected bacteremia in febrile, neutropenic pediatric ALL patients during chemotherapy. The National Comprehensive Cancer Network and Infectious Diseases Society of America encourage immediate, empiric antibiotics in patients with chemotherapy-induced fever and neutropenia to reduce infection-related mortality. No standard recommendation exists for patients with isolated fever at initial presentation of their ALL. This study evaluates bacteremic episodes in this subpopulation of pediatric patients. Methods: We retrospectively analyzed 245 consecutive patients with ALL at Children’s Hospital Oakland from 2000 through 2011. Using electronic medical records, we investigated each patient’s history and outcome. We surveyed bacteremic episodes up to 60 days after presentation per National Healthcare Safety Network’s guidelines. Inclusion criteria were patients with fever at presentation, which prompts a blood culture, and were started on antibiotics. We stratified bacteremic episodes into community-acquired (up to three days from admission) and nosocomial (four to 60 days). Results: Seventy-seven patients met the inclusion criteria, five of whom had positive cultures – four were contaminants (three coagulase-negative Staphylococcus and one non-anthracis Bacillus) and one was a true nosocomial bactermic episode (E coli). There were no infection-related deaths in the first 60 days of diagnosis in this cohort. Conclusions: Given our institution’s rarity of bacteremic episodes, we contemplate a more judicious use of antibiotics, including quicker narrowing of broad-spectrum antibiotics coverage and discontinuing all antibiotics sooner. These modifications may decrease bacterial resistance to antibiotics, reduce costs, and shorten patients’ hospitalization. We encourage other institutions to conduct a similar investigation.

Forecasting asparaginase quantity required to treat pediatric ALL in LMICs using ACCESS FORxECAST.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10031-10031
Author(s):  
Terence M. Hughes ◽  
Brianna Empringham ◽  
Sumit Gupta ◽  
Zachary J. Ward ◽  
Jennifer Yeh ◽  
...  
Keyword(s):  
Lymphoblastic Leukemia ◽  
Cancer Drug ◽  
Middle Income ◽  
E Coli ◽  
Incidence Data ◽  
Crucial Component ◽  
Private And Public ◽  
Pediatric All ◽  
Treat All ◽  
Care Capacity

10031 Background: Asparaginase (ASN) is a crucial component of pediatric acute lymphoblastic leukemia (ALL) protocols. ASN is available in three enzyme formulations: native from Escherichia Coli ( E. coli), PEGylated from E. coli (PEG), and native erwinia from Erwinia chrysanthemi (Erwinase). PEG is typically preferred in high-income countries, while E. coli is more accessible in low and middle income countries (LMICs). Erwinase is reserved for patients who develop hypersensitivity. Short shelf lives, high prices, intermittent availability, and concern for substandard formulations in LMICs have created a need for proactive ASN demand estimates, particularly in LMICs. Methods: We modified FORxECAST, a publicly available tool that forecasts pediatric cancer drug quantity and cost, to estimate ASN quantity required to treat pediatric ALL in 2021 across all LMICs. Incidence data is based on the Global Childhood Cancer microsimulation model, which extrapolates country registries to estimate diagnosed pediatric ALL patients. We forecast ASN quantity for both a base regimen (BR), recommended by the International Pediatric Oncology Society (SIOP), and a more aggressive regimen (AR) used in some LMICs with more advanced supportive care capacity. For both BR and AR, we estimate ASN quantity across four scenarios, outlining how quantity would vary based on formulation and ability to switch in cases of hypersensitivity. Results: The estimated quantity of ASN required to treat all children diagnosed with ALL in LMICs in 2021, across scenarios and regimens, is provided (Table). If E. coli were used to treat all diagnosed pediatric ALL patients across LMICs, required quantity would range from 1,198 M IU (BR) to 1,661 M IU (AR) (Scenario 1). If PEG were used, required quantity would range 150 M IU (BR) to 473 M IU (AR) (Scenario 2). Accounting for hypersensitivity would require 77 M IU (BR) to 137 M IU (AR) Erwinase (Scenarios 3 and 4). Conclusions: We adapted FORxECAST to be ASN-specific and estimated demand in LMICs for a range of scenarios, including for second line Erwinase; accounting for hypersensitivity is particularly important because discontinuation typically results in lower cure rates. We also estimated how quantity of ASN required would increase with treatment intensity. These results provide the first quantification of ASN need for pediatric ALL in LMICs, creating a demand estimate that can inform private and public efforts to produce a reliable supply of high quality ASN for all children with ALL.[Table: see text]

scholarly journals Crisis management in the treatment of childhood acute lymphoblastic leukemia: putting right what can go wrong (emergency complications of disease and treatment)

Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 251-258 ◽  
Author(s):  
Rachael Hough ◽  
Ajay Vora
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Tumor Lysis Syndrome ◽  
Treatment Delays ◽  
Life Threatening ◽  
Pediatric All ◽  
Short And Long Term ◽  
Dose Reductions ◽  
Related Mortality

AbstractThe improvement in overall survival in children with acute lymphoblastic leukemia (ALL) over the last 5 decades has been considerable, with around 90% now surviving long term. The risk of relapse has been reduced to such an extent that the risk of treatment-related mortality is now approaching that of mortality caused by relapse. Toxicities may also lead to the suboptimal delivery of chemotherapy (treatment delays, dose reductions, dose omissions), potentially increasing relapse risk, and short- and long-term morbidity, adding to the “burden of therapy” in an increasing number of survivors. Thus, the need to reduce toxicity in pediatric ALL is becoming increasingly important. This work focuses on the risk factors, pathogenesis, clinical features, and emergency management of the life-threatening complications of ALL at presentation and during subsequent chemotherapy, including leucostasis, tumor lysis syndrome, infection, methotrexate encephalopathy, thrombosis, and pancreatitis. Potential strategies to abrogate these toxicities in the future are also discussed.

scholarly journals ANGKA KEJADIAN DIARE PADA ANAK DENGAN LEUKEMIA LIMFOBLASTIK AKUT DI RSUP PROF. DR. R. D. KANDOU MANADO PERIODE TAHUN 2011-2015

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Fatmawati Latamu ◽  
Jeanette I. Ch. Manoppo ◽  
Max F. J. Mantik
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Medical Records ◽  
Lymphoblastic Leukemia ◽  
Transmitted Disease ◽  
The Body ◽  
Induction Phase ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Common Cause ◽  
Foreign Objects

ABSTRACTBackground : Leukemia is a type of non-transmitted disease that cause death with a large number of cases, especially in children. Leukemia is the most common childhood cancer. Acute Lymphoblastic Leukemia (ALL) is approximately 75% of all cases. One of the main consequences of leukemia is inability of the immune system defending the body from the invasion of foreign objects. As a result of infection or bleeding is the most common cause of death in patient with leukemia. Diarrhea is one of the infections that can be found in children with Acute Lymphoblastic Leukemia. Diarrhea in children with Acute Lymphoblastic Leukemia can occur either from the disease itself or due to chemotherapy. The purpose of this study is to describe the incidence of diarrhea in children with acute lymphoblastic leukemia in Prof. R. D. Kandou Hospital Manado year period 2011-2015.Methods : This study is a descriptive retrospective, with cross sectional approach by collecting data medical records of pediatric patient with ALL in RSUP Prof. Dr. R. D. Kandou Manado then describe the incidence of diarrhea. Samples were 60.Results : The result obtained 60 patients who met the inclusion criteria, and 17 patients had diarrhea. Diarrhea in children with ALL is more common in induction phase, and the duration of diarrhea more to less than 7 days (acute diarrhea).Conclusion : From this result, it can be concluded that the incidence of diarrhea in children with Acute Lymphoblastic Leukemia in Prof. DR. R. D. Kandou Hospital Manado year period 2011-2015 is low enough.Keywords : Acute Lymphoblastic Leukemia (ALL), Diarrhea, ChildABSTRAKLatar Belakang : Leukemia merupakan jenis penyakit tidak menular yang menyebabkan kematian dengan jumlah kasus yang tidak sedikit khususnya pada anak-anak. Leukemia adalah kanker anak yang paling sering. Leukemia Limfoblastik Akut (LLA) berjumlah kira-kira 75% dari semua kasus. Salah satu konsekuensi utama dari Leukemia adalah ketidakmampuan sistem imum mempertahankan tubuh dari invasi benda asing. Akibatnya infeksi atau perdarahan hebat adalah penyebab tersering kematian pada pasien leukemia. Diare merupakan salah satu infeksi yang dapat dijumpai pada anak dengan Leukemia Limfoblastik Akut. Diare pada anak dengan Leukemia Limfoblastik Akut dapat terjadi baik akibat dari Leukemia Limfoblastik Akut itu sendiri maupun akibat dari kemoterapi yang diberikan.Metode : Penelitian ini bersifat retrospektif deskriptif, dengan pendekatan potong lintang dengan cara mengumpulkan rekam medik pasien anak dengan LLA di RSUP Prof. Dr. R. D. Kandou Manado, kemudian mendeksripsikan kejadian diare.Hasil : Didapatkan 60 pasien yang memenuhi kriteria inklusi, dan 17 pasien mengalami diare. Diare pada anak dengan LLA lebih sering terjadi pada fase induksi, dan lamanya diare lebih banyak pada < 7 hari (diare akut).Kesimpulan : Angka kejadian diare pada anak dengan Leukemia Limfoblastik Akut di RSUP Prof. DR. R. D. Kandou periode tahun 2011-2015 cukup rendah.Kata Kunci : Leukemia Limfoblastik Akut (LLA), Diare, Anak

scholarly journals Quantitative Antibiotic Use Profile in Typhoid

2020 ◽  
Vol 3 (3) ◽  
pp. 113-118
Author(s):  
Hidayatul Kurniawati ◽  
Marianti
Keyword(s):  
Typhoid Fever ◽  
Medical Records ◽  
Bacterial Resistance ◽  
Antibiotic Use ◽  
Drug Side Effects ◽  
Inclusion Criteria ◽  
Adult Age ◽  
Retrospective Data Collection ◽  
The Right ◽  
Age Range

Background. Typhoid fever is a common health problem in developing countries. Antibiotics are used to treat typhoidfever which is caused by a bacterial infection. Selection and use of appropriate and rational antibiotic therapy candetermine a success in treatment to avoid bacterial resistance and minimize drug side effects. This study aims todetermine the rationality of the use of antibiotics in adult patients diagnosed with typhoid fever in the InpatientInstallation of X Hospital in Yogyakarta. Method. Non-experimental research with descriptive observational researchdesign and retrospective data collection. The sample of this study was inpatients with a diagnosis of typhoid fever andwas recorded at the X Hospital Medical Records Installation in Yogyakarta for the period January 2016 - December2017 which was included in the inclusion criteria. Result. Data taken came from 75 medical records that were includedin the inclusion criteria. Patients were dominated by female patients as many as 64% and the adult age range was 18-30 years. The single most widely used antibiotic was levofloxacin in 27 cases (36%). The use of antibiotics with theright indication was 75 patients (100%), the right type was 75 patients (100%), the exact duration of administrationwas 64 patients (85.33%), the right dose was 73 patients (97.33%), the right interval was 73 patients (97.33%) and theright route of administration were 75 patients (100%). Conclusion. The rationality of using antibiotics is good withaccuracy> 75%.

scholarly journals Analysis of Patients Undergoing Prostate Biopsy Procedure In Outpatient Care

2021 ◽  
Author(s):  
Patrícia Mitsue Saruhashi Shimabukuro ◽  
Carla Morales Guerra ◽  
RICHARLISSON BORGES DE MORAIS ◽  
Monica Taminato
Keyword(s):  
Emergency Care ◽  
Prostate Biopsy ◽  
Medical Records ◽  
Signs And Symptoms ◽  
Hospital Environment ◽  
Inclusion Criteria ◽  
Salmonella Spp ◽  
E Coli ◽  
Total Sensitivity

Abstract Currently in the concept of de-hospitalization and consequently an increase in invasive procedures performed in the extra-hospital environment. This work aims to identify the signs and symptoms of an adverse event related to prostate biopsy. This is a cohort and retrospective research through the registration of patient care in electronic medical records after the exam. In the period from 2016 to 2018, 3,570 exams were performed, with 491 patients presenting the criteria for the classification of infection related to the procedure that strictly obeys the criteria established by the Centers Diseases Control (CDC). The inclusion criteria for patients were those who, within 15 days after performing the prostate biopsy, had emergency care due to the presence of signs and symptoms. The exams analyzed were urine culture and blood culture collected at the time of emergency care. The results were that of the 491 patients evaluated, 38 (9%) patients required hospitalization, the average age of the hospitalized patients was 71.5 years and all had at least one associated comorbidity on positive cultures, 13 for E. coli with total sensitivity to aminoglycosides and carbapenems and partial sensitivity to fluoroquinolones, 1 Protein spp sensitive to aminoglycosides and carbapenems and 1 Salmonella spp sensitive to fluoroquinolones and carbapenems. Thus, it is noted the importance of the infection control nurse's activity in the diagnostic medicine units for the elaboration of protocols adapted to the outpatient reality.

Distribution of Common Pathogens and Bacterial Resistance in A Tertiary Hospital in China

2021 ◽  
Vol 7 (5) ◽  
pp. 1736-1745
Author(s):  
Jing Ping ◽  
Naiwei Li ◽  
Le Huang ◽  
Zhaohua Zhou ◽  
Xihong Zhang ◽  
...  
Keyword(s):  
Bacterial Resistance ◽  
Tertiary Hospital ◽  
Drug Susceptibility ◽  
Resistance Rate ◽  
Coagulase Negative Staphylococcus ◽  
Detection Rates ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Resistant Strains ◽  
Resistance Rates

We aimed to explore the distribution of common pathogens and bacterial resistance in our hospital from 2017 to 2020, and to standardize clinical medication guidance. The pathogens isolated from the submitted specimens were identified, and drug susceptibility results were interpreted according to the Clinical and Laboratory Standards Institute guidelines (2017-2020). A total of 43,588 specimens were collected from patients treatedfrom 2017 to 2020, and 6,285 strains of pathogens were isolated. The most common pathogens were Escherichia coli, Haemophilus influenzae and Klebsiella pneumoniae.Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 32.85%, and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) accounted for 78.79%. The resistance rates of MRSA and MRCNS to ciprofloxacin, levofloxacin, erythromycin, clindamycin and trimethoprim-sulfamethoxazole were significantly higher than those of methicillin-sensitive S. aureus and methicillin-sensitive coagulase-negative Staphylococcus. The resistance rate of Streptococcus pneumoniae to erythromycin, tetracycline and clindamycin was higher than 80%. The detection rates of E. coli and K. pneumoniae producing ESBL strains were 62.2% and 25.6%, respectively. Totally, 769 carbapenem-resistant strains were detected, of which carbapenem-resistant Acinetobacter baumannii (CRAB) accounted for 66.6%, followed by carbapenem-resistant K. pneumoniae (CRKP) and carbapenem-resistant Pseudomonas aeruginosa (CRPA). A total of 202 CRE strains were detected, which were mainly isolated from respiratory tract and urine specimens. CRAB, CRKP and CRPA had higher resistance rates to antibacterial drugs. Gram-negative bacilli are the most common pathogens from 2017 to 2020. Considering that pathogens have high drug resistance, it is recommended to strengthen clinical management and rational application of antibiotics, thus reducing the risk of nosocomial infections.

scholarly journals Encouraging Results with ALL IC-BFM 2009 Protocol Therapy in Pediatric Acute Lymphoblastic Leukemia/Lymphoma in Resource-Limited Setting: A Single-Center Study from India

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5118-5118
Author(s):  
Uttam Kumar Nath ◽  
Debranjani Chattopadhyay ◽  
Anamika Bakliwal ◽  
Sudeep Vaniyath ◽  
Rituparna Chetia ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Lymphoblastic Leukemia ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Maintenance Phase ◽  
Free Survival ◽  
Resource Limited ◽  
Pediatric All ◽  
Related Mortality

Background: Acute lymphoblastic leukemia (ALL) is the commonest cancer in children. The survival rates in pediatric ALL have improved to 80-90% in high-income countries, where the goal of current risk-adapted treatment protocols is to minimize treatment-related mortality. In contrast, cure/survival rates are still lower in low-income countries, due to combined effect of disease-related factors, high incidence of treatment abandonment, higher rates of relapse, & higher treatment-related mortality. The Berlin-Frankfurt-Münster (BFM) protocol versions are commonly used for treatment of pediatric ALL in many centers. There is no published data on treatment outcomes with ALL IC-BFM 2009 protocol in pediatric ALL in India. Objective: The study aims to evaluate the treatment outcomes in Indian pediatric ALL/LBL patients treated with ALL IC-BFM 2009 protocol under severe resource-limited settings, in terms of morphological complete remission (CR), minimal residual disease (MRD) status, and disease-free survival. Methods: Our study enrolled 25 newly diagnosed pediatric ALL/LBL patients (age ≤18 years) between February 2018 & June 2019. Induction chemotherapy was initiated as per ALL IC-BFM 2009 protocol after obtaining informed consent. Risk stratification was done as per protocol into standard risk (SR), intermediate risk (IR), and high risk (HR) groups, based on age, baseline leukocyte count, cytogenetics & molecular study findings, day 8 steroid response (peripheral blood absolute blast count), bone marrow MRD by flowcytometry on day 15, and bone marrow morphological response on days 15 & 33 of induction phase. Additional imaging was done to assess response in LBL patients. Central nervous system (CNS)-directed therapy with intrathecal chemotherapy was administered as per protocol. Post-induction therapy consisted of an augmented early intensification phase, risk-adapted consolidation therapy phase, a delayed intensification (reinduction) phase, & maintenance phase. Therapeutic cranial radiation (18 Gy) was administered only to patients with documented CNS leukemia. Results: Of the total 25 patients, 17 had B-ALL, six had T-ALL & two had T-LBL. Median age of patients was 9 years (2-18 years), with 11 boys & 14 girls. All the patients had BCR-ABL negative disease; three patients had t(12;21)(p13;q22)/ETV6-RUNX1. Seven patients (28%) had hyperleukocytosis (leukocyte count >1,00,000/µL) and two patients had CNS leukemia at presentation. Nine out of the 25 patients (36%) were in high risk group as per criteria. Eight patients (32%) had poor steroid response on day 8 of induction (PB blasts ≥ 1000/µL). Six patients had M3 marrow on day 15 (>25% blasts in marrow). Day 15 bone marrow MRD was <0.1% in 13 patients (52%), >0.1% in 7 patients (28%) and could not be done in 5 patients (including the two T-LBL patients). Twenty-three out of 25 patients (92%) achieved morphological CR (marrow blasts <5%) on day 33. There were two deaths in induction; both patients were not in CR as per day 33 bone marrow morphology criteria. One B-ALL patient in HR group died of early medullary relapse. The remaining 22 patients are in CR & doing well on follow up, and four of them have started maintenance phase therapy. The results are summarized in Table 1. Conclusion: Our preliminary results with ALL IC-BFM 2009 treatment protocol in Indian pediatric ALL/LBL patients are encouraging, with 92% complete remission rate, 88% disease-free survival and manageable treatment-related toxicity in spite of severe resource constraints. Long-term follow up & enrollment of higher number of patients is planned. Disclosures No relevant conflicts of interest to declare.

scholarly journals HUBUNGAN KARAKTERISTIK PASIEN DENGAN TOKSISITAS HEPATOLOGI AKIBAT PENGGUNAAN 6-MERKAPTOPURIN DALAM FASE PEMELIHARAAN PADA PASIEN PEDIATRI KANKER LEUKIMIA LIMFOBLASTIK AKUT DI RS KANKER DHARMAIS JAKARTA

2020 ◽  
Vol 3 (2) ◽  
pp. 361-368
Author(s):  
Nazhipah Isnani ◽  
◽  
Dyah Aryani Perwitasari ◽  
Rizka Andalusia ◽  
Haridini Intan Mahdi ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Medical Records ◽  
Pediatric Patients ◽  
Lymphoblastic Leukemia ◽  
Maintenance Phase ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Cancer Hospital ◽  
Phase Data ◽  
Observational Design

Mercaptopurine is a chemotherapy drug that used in the consolidation and maintenance phase in pediatric patients with acute lymphoblastic leukemia ( ALL). Mercaptopurine is supposed to have relationship with the occurrence of toxicity in hepatology. This study was aimed to determine the patient incidence , severity and management of toxicity and risk factors that affect the occurrence of hepatologic toxicity using of 6 - MP in the maintenance phase in pediatric patients with acute lymphoblastic leukemia in Dharmais Cancer Hospital Jakarta. This research was carried out by cross-sectional observational design with data was taken retrospectively and prospectively during the period from March to April 2014. The study subjects were patient who have been getting treatment of maintenace phase in Dharmais Cancer Hospital Jakarta from 2013 until March-April 2014. The Subjects who met the inclusion criteria were 23 patients of ALL received 6 - MP in the maintenance phase. Data was collected by looking at the medical records for getting of the patient's identity and data hepatology. The result showed that there was a correlation between patient characterision on hepatology toxicity, on SGOT age and weight with SGPT both of them has significant value, it was 0,036 (P<0,05)

Targeting Kinase-activating Genetic Lesions to Improve Therapy of Pediatric Acute Lymphoblastic Leukemia

2018 ◽  
Vol 25 (24) ◽  
pp. 2811-2825 ◽  
Author(s):  
Raffaella Franca ◽  
Natasa K. Kuzelicki ◽  
Claudio Sorio ◽  
Eleonora Toffoletti ◽  
Oksana Montecchini ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Fusion Gene ◽  
Hematologic Malignancy ◽  
Lymphoblastic Leukemia ◽  
Point Of View ◽  
Lymphoid Cells ◽  
Gene Encoding ◽  
Pediatric All ◽  
Blast Cells ◽  
Tk Inhibitors

Acute lymphoblastic leukemia (ALL) is the most common hematologic malignancy in children, characterized by an abnormal proliferation of immature lymphoid cells. Thanks to risk-adapted combination chemotherapy treatments currently used, survival at 5 years has reached 90%. ALL is a heterogeneous disease from a genetic point of view: patients’ lymphoblasts may harbor in fact several chromosomal alterations, some of which have prognostic and therapeutic value. Of particular importance is the translocation t(9;22)(q34;q11.2) that leads to the formation of the BCR-ABL1 fusion gene, encoding a constitutively active chimeric tyrosine kinase (TK): BCR-ABL1 that is present in ~3% of pediatric ALL patients with B-immunophenotype and is associated with a poor outcome. This type of ALL is potentially treatable with specific TK inhibitors, such as imatinib. Recent studies have demonstrated the existence of a subset of BCR-ABL1 like leukemias (~10-15% of Bimmunophenotype ALL), whose blast cells have a gene expression profile similar to that of BCR-ABL1 despite the absence of t(9;22)(q34;q11.2). The precise pathogenesis of BCR-ABL1 like ALL is still to be defined, but they are mainly characterized by the activation of constitutive signal transduction pathways due to chimeric TKs different from BCR-ABL1. BCR-ABL1 like ALL patients represent a group with unfavorable outcome and are not identified by current risk criteria. In this review, we will discuss the design of targeted therapy for patients with BCR-ABL1 like ALL, which could consider TK inhibitors, and discuss innovative approaches suitable to identify the presence of patient’s specific chimeric TK fusion genes, such as targeted locus amplification or proteomic biosensors.

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