acute lymphoblastic leukaemia
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2022 ◽  
Vol 9 ◽  
Author(s):  
Charlotte Calvo ◽  
Leila Ronceray ◽  
Nathalie Dhédin ◽  
Jochen Buechner ◽  
Anja Troeger ◽  
...  

Adolescents and young adults (AYAs) represent a challenging group of acute lymphoblastic leukaemia (ALL) patients with specific needs. While there is growing evidence from comparative studies that this age group profits from intensified paediatric-based chemotherapy, the impact and optimal implementation of haematopoietic stem cell transplantation (HSCT) in the overall treatment strategy is less clear. Over recent years, improved survival rates after myeloablative allogeneic HSCT for ALL have been reported similarly for AYAs and children despite differences in transplantation practise. Still, AYAs appear to have inferior outcomes and an increased risk of treatment-related morbidity and mortality in comparison with children. To further improve HSCT outcomes and reduce toxicities in AYAs, accurate stratification and evaluation of additional or alternative targeted treatment options are crucial, based on specific molecular and immunological characterisation of ALL and minimal residual disease (MRD) assessment during therapy. Age-specific factors such as increased acute toxicities and poorer adherence to treatment as well as late sequelae might influence treatment decisions. In addition, educational, social, work, emotional, and sexual aspects during this very crucial period of life need to be considered. In this review, we summarise the key findings of recent studies on treatment approach and outcomes in this vulnerable patient group after HSCT, turning our attention to the different approaches applied in paediatric and adult centres. We focus on the specific needs of AYAs with ALL regarding social aspects and supportive care to handle complications as well as fertility issues. Finally, we comment on potential areas of future research and concisely debate the capacity of currently available immunotherapies to reduce toxicity and further improve survival in this challenging patient group.


2022 ◽  
Vol 9 ◽  
Author(s):  
Matthias Wölfl ◽  
Muna Qayed ◽  
Maria Isabel Benitez Carabante ◽  
Tomas Sykora ◽  
Halvard Bonig ◽  
...  

Acute graft-versus-host disease (aGvHD) continues to be a leading cause of morbidity and mortality following allogeneic haematopoietic stem cell transplantation (HSCT). However, higher event-free survival (EFS) was observed in patients with acute lymphoblastic leukaemia (ALL) and grade II aGvHD vs. patients with no or grade I GvHD in the randomised, controlled, open-label, international, multicentre Phase III For Omitting Radiation Under Majority age (FORUM) trial. This finding suggests that moderate-severity aGvHD is associated with a graft-versus-leukaemia effect which protects against leukaemia recurrence. In order to optimise the benefits of HSCT for leukaemia patients, reduction of non-relapse mortality—which is predominantly caused by severe GvHD—is of utmost importance. Herein, we review contemporary prophylaxis and treatment options for aGvHD in children with ALL and the key challenges of aGvHD management, focusing on maintaining the graft-versus-leukaemia effect without increasing the severity of GvHD.


2022 ◽  
Vol 15 (1) ◽  
pp. 101291
Author(s):  
Ana Luiza Tardem Maciel ◽  
Thayana da Conceição Barbosa ◽  
Caroline Barbieri Blunck ◽  
Karolyne Wolch ◽  
Amanda de Albuquerque Lopes Machado ◽  
...  

Author(s):  
Benjamin Micallef ◽  
Robert G. Nistico ◽  
Sinan.B. Sarac ◽  
Ole Weis Bjerrum ◽  
Dianne Butler ◽  
...  

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e048325
Author(s):  
Katarina Aili ◽  
Susann Arvidsson ◽  
Maria Olsson ◽  
Marianne Jarfelt ◽  
Jens Nygren

IntroductionAcute lymphoblastic leukaemia (ALL) is the most common form of cancer in children. Although treatment methods have improved and resulted in significant improvement of survival and reduction in late effects and late mortality risk, the health-related quality of life (HRQOL) of survivors might be affected. To introduce new interventions in clinical practice with the potential to support positive HRQOL outcomes, more knowledge is needed on how HRQOL in this group is constructed and stimulated. The purpose of this study is to investigate how HRQOL is affected in adults treated for paediatric ALL, in a long-term perspective and possible factors influencing this relationship.Methods and analysisThis cohort of young adult ALL survivors allows for investigations of factors influencing HRQOL outcomes on a national level. Eligible participants are obtained from the Swedish Childhood Cancer quality registry. Data collection includes both a follow-up of data collected in 2012 (n=224) and recruitment of new eligible participants to the cohort (n=601). The cohort will cover survivors of paediatric ALL, diagnosed between 1985 and 2007, at an age between 0 and 15 years. Data will be collected using validated, multidimensional, self-administered instruments, designed to measure HRQOL (SF-36), social support, sense of coherence and resilience.Ethics and disseminationThe study will be carried out in accordance with the ethics permit obtained from the Swedish ethics review authority (Dnr 2019-05181). Dissemination of study results will take place through research articles and reports to the national patient organisation and the national network for consultancy nurses for this target group and to the working group for the Swedish national long-term care programme for childhood cancer. Results will also reach practical application within the follow-up clinic for adult childhood cancer survivors at Sahlgrenska Hospital in Gothenburg.


2022 ◽  
Vol 8 (4) ◽  
pp. 79-82
Author(s):  
Prashant Motiram Mulawkar ◽  
Sumit Gopal Agrawal ◽  
Narendra Bhikulal Rathi ◽  
Gaurav Shivprakash Mantri ◽  
Deepak R Bhat

2021 ◽  
Author(s):  
Salvador Chulian ◽  
Bernadette J. Stolz ◽  
Alvaro Martinez-Rubio ◽  
Cristina Blazquez Goni ◽  
Juan Francisco Rodriguez Gutierrez ◽  
...  

Acute Lymphoblastic Leukaemia (ALL) is the most frequent paediatric cancer. Modern therapies have improved survival rates, but approximately 15-20 % of patients relapse. At present, patients' risk of relapse are assessed by projecting high-dimensional flow cytometry data onto a subset of biomarkers and manually estimating the shape of this reduced data. Here, we apply methods from topological data analysis (TDA), which quantify shape in data via features such as connected components and loops, to pre-treatment ALL datasets with known outcomes. We combine these fully unsupervised analyses with machine learning to identify features in the pre-treatment data that are prognostic for risk of relapse. We find significant topological differences between relapsing and non-relapsing patients and confirm the predictive power of CD10, CD20, CD38, and CD45. Further, we are able to use the TDA descriptors to predict patients who relapsed. We propose three prognostic pipelines that readily extend to other haematological malignancies.


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