Update in Pediatric Oncology: Section A-New Developments in the Treatment of Pediatric Acute Lymphoblastic Leukemia

Abstract

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, affecting approximately 2900 children and adolescents in the United States each year (Ries et al., SEER Program, 1999). Although survival has improved from less than 10% a half century ago to almost 90% today, ALL remains the leading cause of pediatric cancer deaths (Hunger et al., J Clin Oncol 30(14):1663–9, 2012; Smith et al., J Clin Oncol 28(15):2625–34, 2010). From the first introduction of single-agent chemotherapy in the 1940s, combination chemotherapy and intensification of post-induction therapy have largely been responsible for advances in the treatment of ALL, as has therapy directed at the central nervous system (CNS). Over time, the stratification of patients by their risk of relapse, such that therapy intensity is tailored to this risk, has been a major contributor to both improvements in survival rates and reductions in toxicity from therapy. Clinical features, leukemia biology, and early response to therapy have emerged as important components of risk stratification. The biology of ALL, key prognostic factors, and treatment approaches will be discussed, with an emphasis on new developments in the treatment of pediatric ALL.