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Chapter 17
Acute lymphoblastic leukemia and lymphoblastic lymphoma
Acute lymphoblastic leukemia (ALL) is the most common leukemia in children (representing 23% of cancer diagnoses among children younger than 15 years of age) but accounts for only 20% of adult acute leukemia. The prognosis for both adult and especially childhood ALL has improved substantially in recent years with the use of risk-directed induction-consolidation-continuation (maintenance) regimens that include central nervous system (CNS) prophylaxis. In children, treatment now results in complete remission (CR) rates of 97% to 99% and in 5-year event-free survival rates of 75% to 86% (Pui et al, 2008, 2009). The use of similar treatment
Classification and diagnosis of ALL
Immunophenotyping
Cytogenetics
Molecular genetics
Prognostic factors
Clinical prognostic factors Cytogenetic and molecular genetic prognostic factors Minimal residual disease detection
Treatment of ALL
Supportive care Treatment of Burkitt lymphoma/leukemia in children and adults Treatment of precursor B-cell and precursor T-cell ALL in children Remission induction Intensification (consolidation) therapy Maintenance (continuation) therapy CNS-directed treatment Stem cell transplantation Treatment for relapse in children Targeted therapies Special subgroups of ALL in children Treatment of precursor B-cell and T-cell ALL in adults Induction phase Consolidation therapy CNS prophylaxis Maintenance therapy Risk-directed treatment of adult ALL Ph+ ALL Adolescents and young adults Allo-SCT in adult ALL in CR1 Relapsed disease Allo-SCT beyond CR1 Novel therapies
Lymphoblastic lymphoma
Late complications of therapy
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