Advance in the Treatment of Pediatric Leukemia
A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Hematology".
Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 86832
Special Issue Editor
Interests: stem cell transplantation; immunotherapy
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Dear Colleagues,
Since the introduction of chemotherapy for the treatment of children with leukemia, tremendous progress has been made and most patients can be cured of their disease. While in the beginning, all patients received the same chemotherapy, risk-adapted chemotherapeutic strategies have been developed over time with less chemotherapy for some and more intensive chemotherapy, including allogeneic stem cell transplantation, for others. Detailed analysis of the genomic landscape of leukemic blasts, allowing for precision medicine and the introduction of the concept of MRD (minimal residual disease) response, has led to better stratification of various chemotherapeutic approaches and to an improved outcome and long-term survival. However, many children with leukemia will carry the burden of more or less intensive chemotherapy into adulthood. Therefore, new therapeutic approaches with less intensive chemotherapy should be investigated without compromising the good long-term survival. An example of such a strategy is the reduction in the risk of therapy-induced brain tumors by the omission of cranial irradiation in most patients with acute lymphoblastic leukemia (ALL) without compromising their good outcome. Progress has also been made in the field of allogeneic stem cell transplantation through improved donor selection and reductions in the morbidity and mortality of this approach. More recently, tremendous progress has been seen with the introduction of highly effective immunotherapeutic strategies, such as the use of bispecific T-cell engagers (BiTEs) and the use of chimeric antigen receptor (CAR) T-cells. Both approaches have shown impressive remission rates in children with chemotherapy-refractory pre-B ALL. Similar strategies are under investigation for the treatment of patients with T-cell leukemias (T-ALL) and acute myeloid leukemias (AML). A few carefully planned studies with more frontline immunotherapy and less chemotherapy are under way and more such studies focusing on early immunotherapy will be initiated in the future, which would allow us to significantly reduce the long-term burden of intensive chemotherapy for the affected children.
Prof. Dr. Rupert Handgretinger
Guest Editor
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Keywords
- acute lymphoblastic leukemia
- acute myeloid leukemia
- chemotherapy
- allogeneic stem cell transplantation
- genomic landscape
- precision medicine
- immunotherapy
- bispecific T-cell engager (BiTEs)
- CAR T-cells
- long-term side effects
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