The Paper Symposium on PLC VIRAL HEPATITIS（HBV AND HCV）BACKGROUND IN CHINESE PATIENTS WITH HEPATOCELLULAR CARCINOMA

ＴｈｅＰａｐｅｒＳｙｍｐｏｓｉｕｍｏｎＰＬＣＶＩＲＡＬＨＥＰＡＴＩＴＩＳ（ＨＢＶＡＮＤＨＣＶ）ＢＡＣＫＧＲＯＵＮＤＩＮＣＨＩＮＥＳＥＰＡＴＩＥＮＴＳＷＩＴＨＨＥＰＡＴＯＣＥＬＬＵＬＡＲＣＡＲＣＩＮＯＭＡＹｕＺｈｕｙｕａｎ；余竹元；ＴａｎｇＺｈａｏｙｏ...     

THE EFFECT OF HYPO－OSMOLAR SOLUTIONS WITH HIBITANE ON SHED CANCER CELLS IN PERITONEAL CAVITY OF PATIENTS WITH GASTRIC CANCER

ＴＨＥ　ＥＦＦＥＣＴＯＦＨＹＰＯ－ＯＳＭＯＬＡＲ　ＳＯＬＵＴＩＯＮＳ　ＷＩＴＨ　ＨＩＢＩＴＡＮＥＯＮ　ＳＨＥＤ　ＣＡＮＣＥＲ　ＣＥＬＬＳ　ＩＮ　ＰＥＲＩＴＯＮＥＡＬ　ＣＡＶＩＴＹ　ＯＦ　ＰＡＴＩＥＮＴＳ　ＷＩＴＨ　ＧＡＳＴＲＩＣ　ＣＡＮＣＥＲＤａｉＤ...     

ENHANCEMENT OF MORPHOLOGICAL AND ONCOGENIC TRANSFORMATION OF MOUSE CELLS WITH 12－O－TETRA－DECANOYL PHORBOL－13－ACETATE FOLLOWIN

ＥＮＨＡＮＣＥＭＥＮＴＯＦＭＯＲＰＨＯＬＯＧＩＣＡＬＡＮＤＯＮＣＯＧＥＮＩＣＴＲＡＮＳＦＯＲＭＡＴＩＯＮＯＦＭＯＵＳＥＣＥＬＬＳＷＩＴＨ１２－Ｏ－ＴＥＴＲＡＤＥＣＡＮＯＹＬＰＨＯＲＢＯＬ－１３－ＡＣＥＴＡＴＥＦＯＬＬＯＷＩＮＧＨＥＲＰＥＳＳＩＮＰＬＥ...     

小细胞肺癌联合化疗及免疫组化研究

６８例小细胞肺癌（ＳＣＬＣ）用ＣＯＣＥ及ＣＯＭＰ方案化疗，２２例化疗后放疗，其中１４例纤支镜活检标本用神经特异性烯醇化酶（ＮＳＥ），铬粒素Ａ（ＣＧＨ－Ａ），癌胚抗原（ＣＥＡ）和角蛋白（Ｋ）４种抗体进行免疫组化ＡＢＣ法染色。结果总缓解率５８．８％、中位生存期１２．８个月，两方案经卡方检验差异有显著性意义（Ｐ＜０．００５），说明ＣＯＣＥ优于ＣＯＭＰ。化疗加放疗中位生存期１５个月（ＣＯＣＥ１７．３个月，ＣＯＭＰ１２个月），化疗加放疗优于单纯化疗。免疫组化染色结果：ＮＳＥ或／和ＣＧＨ－Ａ阳性者中位生存期２１个月，明显长于ＮＳＥ或／和ＣＧＨ－Ａ阴性者１２个月。ＣＥＡ阳性与阴性者生存时间无明显差异，提示ＳＣＬＣ神经内分泌分化对临床预后的判断有重要的参考价值，而ＣＥＡ对预后的判断作用不明显。     

BRONCHIAL ARTERY CHEMOTHERAPY FOR INOPERABLE NON-SMALL-CELL LUNG CANCER

ＢＲＯＮＣＨＩＡＬＡＲＴＥＲＹＣＨＥＭＯＴＨＥＲＡＰＹＦＯＲＩＮＯＰＥＲＡＢＬＥＮＯＮ－ＳＭＡＬＬ－ＣＥＬＬＬＵＮＧＣＡＮＣＥＲＹａｎｇＺｅｑｕａｎ；杨泽泉；ＹａｎｇＹｕｅ；杨跃；ＬｉｕＷｅｎｈａｉ；刘文海；ＬｉＹｕｅｍｉｎ；李曰民；ＣｈｅｎＨｏｎｇ...     

CHOP-VP16与ProMACE-CytaBOM方案治疗NHL疗效观察

分别采用ＣＨＯＰ－ＶＰ１６方案对５２例和ＰｒｏＭＡＣＥ－ＣｙｔａＢＯＭ方案对３０例非霍奇金淋巴瘤（ＮＨＬ）进行化疗，结果显示，ＣＨＯＰ－ＶＰ１６方案组的完全缓解率为５１．９％（２７／５２），总有效率为９２．３％（４８／５２）；ＰｒｏＭＡＣＥ－ＣｙｔａＢＯＭ方案组的完全缓解率为４３．３％（１３／３０），总有效率为９０．０％（２７／３０）。两组的完全缓解率及总有效率比较，无显著性差异（Ｐ＞０．０５）。两组的主要毒副反应是骨髓抑制，ＣＨＯＰ－ＶＰ１６方案组和ＰｒｏＭＡＣＥ－ＣｙｔａＢＯＭ方案组的白细胞下降（Ⅰ～Ⅲ度）分别为８２．７％（４３／５２）和８３．３％（２５／３０），但均无Ⅳ度下降发生，均无与毒性有关的死亡发生。结果表明，ＣＨＯＰ－ＶＰ１６方案治疗ＮＨＬ可以达到ＰｒｏＭＡＣＥ－ＣｙｔａＢＯＭ方案相近的疗效，且使用方便，毒副反应较轻，可作为治疗ＮＨＬ的一线方案     

恶性淋巴瘤骨髓累及的细胞化学特点

目的：用细胞化学染色的方法诊断恶性淋巴瘤骨髓累汲并与白血病相鉴别。方法：细胞化学染色方法：结果：前躯淋巴母细胞性淋巴瘤（ＰＬＢ）、中心小裂细胞性淋巴瘤（Ｓ－ＦＣＣ）和伴毛细胞的脾淋巴瘤（ＳＬＶＣ）ＰＯＸ、ＳＢＢ和ＣＥ均为阴性，ＰＡＳ：Ｓ－ＦＣＣ和ＳＬＶＬ反应弱，ＰＬＢ反应较强，淋巴瘤珠状占２２．２２％，ＡＬＬ珠状占７０．５９％。ＮＡＥ：Ｓ－ＦＣＣ反应强度以＋＋为主，ＳＬＶＬ和ＰＬＢ较弱。ＡＣＰ：Ｓ－ＦＣＣ较ＳＬＶＣ和ＰＬＢ略强，Ｓ－ＦＣＣ和ＳＬＶＣ均可见＋＋＋＋。ＴＲＡＰ：Ｓ－ＦＣＣ阳性率２％－５４％，ＰＬＢ阳性率１０％－１６％，SLVC性率均为１８％，真性组织细胞性淋巴瘤（ＴＨＬ）ＡＣＰ４例均为阳性，阳性率为１００％，１例ＴＲＡＰ阳性。淋巴瘤与ＣＬＬ、ＨＣＬ和ＡＬＬ相比较发现，淋巴瘤较ＣＬＬ和ＡＬＬ ＴＲＡＰ明显增高，Ｓ－ＦＣＣＴ ＳＬＶＣ的ＡＣＰ和ＴＲＡＰ与ＨＣＬ相同，结论：细胞化学染色在诊断淋巴瘤骨髓转移，并与ＡＬＬ和ＣＬＬ相鉴别上有一定的意义，淋巴瘤骨髓累及PAS阳性率和阳性指数较ALL弱。ACP阳性较ALL和CLL强，具有较强的抗酒石酸的功能，但与HCL难鉴别。     

HEPATITIS B AND C VIRUSES AND THEIR INTERACTION IN THE PTHOGENESIS OF HEPATOCELLULAR CARCINOMA

王树林，张耀铮ＨＥＰＡＴＩＴＩＳＢＡＮＤＣＶＩＲＵＳＥＳＡＮＤＴＨＥＩＲＩＮＴＥＲＡＣＴＩＯＮＩＮＴＨＥＰＴＨＯＧＥＮＥＳＩＳＯＦＨＥＰＡＴＯＣＥＬＬＵＬＡＲＣＡＲＣＩＮＯＭＡ￥ＷａｎｇＳｈｕｌｉｎ；ＺｈａｎｇＹａｏｚｈｅｎｇ；（Ｄｅｐａｒｔｍｅｎｔ...     

CLINICOPATHOLOGIC FEATURES AND DIAGNOSISOF COMBINED HEPATOCELLULAR ANDCHOLANGIOCARCINOMA

ＣＬＩＮＩＣＯＰＡＴＨＯＬＯＧＩＣＦＥＡＴＵＲＥＳＡＮＤＤＩＡＧＮＯＳＩＳＯＦＣＯＭＢＩＮＥＤＨＥＰＡＴＯＣＥＬＬＵＬＡＲＡＮＤＣＨＯＬＡＮＧＩＯＣＡＲＣＩＮＯＭＡＬｕＪｉａｎｐｉｎｇ路建平；ＣａｉＷｅｉｍｉｎ蔡为民；ＨａｙａｓｈｉＫｅｉｋｉ１林肇辉...     

COHORT STUDY ON ASSOCIATION OF SMOKING AND AIR POLLUTION WITH LUNG CANCER AMONG 210，000 PERSONS IN SHANGHAI

ＣＯＨＯＲＴＳＴＵＤＹＯＮＡＳＳＯＣＩＡＴＩＯＮＯＦＳＭＯＫＩＮＧＡＮＤＡＩＲＰＯＬＬＵＴＩＯＮＷＩＴＨＬＵＮＧＣＡＮＣＥＲＡＭＯＮＧ２１０，０００ＰＥＲＳＯＮＳ　ＩＮ　ＳＨＡＮＧＨＡＩＤｅｎｇＪｉｅ１；邓杰；ＧａｏＹｕｔａｎｇ；高玉堂；ＷａｎｇＺｈ...     

Patient stratification based on prednisolone-vincristine-asparaginase resistance profiles in children with acute lymphoblastic leukemia.

PURPOSE: To confirm the prognostic value of a drug resistance profile combining prednisolone, vincristine, and l-asparaginase (PVA) cytotoxicity in an independent group of children with acute lymphoblastic leukemia (ALL) treated with a different protocol and analyzed at longer follow-up compared with our previous study of patients treated according to the Dutch Childhood Leukemia Study Group (DCLSG) ALL VII/VIII protocol. PATIENTS AND METHODS: Drug resistance profiles were determined in 202 children (aged 1 to 18 years) with newly diagnosed ALL who were treated according to the German Cooperative Study Group for Childhood Acute Lymphoblastic Leukemia (COALL)-92 protocol. RESULTS: At a median follow-up of 6.2 years (range, 4.1 to 9.3 years), the 5-year disease-free survival probability (pDFS) rate +/- SE was 69% +/- 7.0%, 83% +/- 4.4%, and 84% +/- 6.8% for patients with resistant (PVA score 7 to 9), intermediate-sensitive (PVA score 5 to 6), and sensitive (SPVA score 3 to 4) profiles, respectively (sensitive and intermediate-sensitive v resistant, P 相似文献   

Childhood T-cell acute lymphoblastic leukemia: the Dana-Farber Cancer Institute acute lymphoblastic leukemia consortium experience.

PURPOSE: T-cell acute lymphoblastic leukemia (T-ALL) accounts for 10% to 15% of newly diagnosed cases of childhood acute lymphoblastic leukemia (ALL). Historically, T-ALL patients have had a worse prognosis than other ALL patients. PATIENTS AND METHODS: We reviewed the outcomes of 125 patients with T-ALL treated on Dana-Farber Cancer Institute (DFCI) ALL Consortium trials between 1981 and 1995. Therapy included four- or five-agent remission induction; consolidation therapy with doxorubicin, vincristine, corticosteroid, mercaptopurine, and weekly high-dose asparaginase; and cranial radiation. T-ALL patients were treated the same as high-risk B-progenitor ALL patients. Fifteen patients with T-cell lymphoblastic lymphoma were also treated with the same high-risk regimen between 1981 and 2000. RESULTS: The 5-year event-free survival (EFS) rate for T-ALL patients was 75% +/- 4%. Fourteen of 15 patients with T-cell lymphoblastic lymphoma were long-term survivors. There was no significant difference in EFS comparing patients with T-ALL and B-progenitor ALL (P =.56), although T-ALL patients had significantly higher rates of induction failure (P <.0001), and central nervous system (CNS) relapse (P =.02). The median time to relapse in T-ALL patients was 1.2 years versus 2.5 years in B-progenitor ALL patients (P =.001). There were no pretreatment characteristics associated with worse prognosis in patients with T-ALL. CONCLUSION: T-ALL patients fared as well as B-progenitor patients on DFCI ALL Consortium protocols. Patients with T-ALL remain at increased risk for induction failure, early relapse, and isolated CNS relapse. Future studies should focus on the identification of and treatment for T-ALL patients at high risk for treatment failure.     

Long-term follow-up of childhood acute lymphoblastic leukemia in Tokyo Children's Cancer Study Group 1981-1995.

The objectives were as follows: Firstly, to estimate the overall probability of event-free survival (EFS) and isolated CNS relapse in the studies for children with acute lymphoblastic leukemia (ALL) during the 1980s and 1990s. Secondly, to report the EFS according to presenting features and lineage. Thirdly, to evaluate the treatment results re-classified by the risks of NCI criteria. Four consecutive protocol studies were performed in the Tokyo Children's Cancer Study Group: L81-10 protocol (1981-1984, 189 patients), L84-11 (1984-1989, 484 patents), L89-12 (1989-1992, 418 patients) and L92-13 (1992-1995, 347 patients). Overall EFS at 5 years in each protocol was 56.5 +/- 3.8(1 s.e.)%, 71.0 +/- 2.1%, 67.8 +/- 2.3%, and 63.4 +/- 2.7%, respectively. The cumulative isolated CNS relapse rate at 5 years was 8.1 +/- 2.1%, 3.5 +/- 0.9%, 3.6 +/- 1.0%, 1.0 +/- 0.6. The EFS in SR/HR (standard risk/high risk) according to the NCI criteria in B-precursor ALL at 5 years was 61.9 +/- 4.3%/41.4 +/- 7.4% (lineage was not confirmed.), 72.5 +/- 2.6%/63.4 +/- 5.0%, 77.4 +/- 2.7%/56.3 +/- 4.7%, and 67.8 +/- 3.4%/56.7 +/- 5.4% in each protocol. Also EFSs according to NCI SR/HR at 5 years of T-ALL in protocols L84-11, L89-12 and L92-13 were 55.6 +/- 16.6%/60.9 +/- 10.1%, 72.7 +/- 13.4%/51.6 +/- 9.1%, and 77.1 +/- 14.4%/53.6/10.1%, respectively. The truncation of maintenance therapy to 6 months resulted in a decreased EFS in L92-13, particularly due to an increase of bone marrow relapse after cessation of therapy in SR and HR. The NCI risk criteria work properly even in the patients treated by different intensities, so that it makes the comparison possible among the patients in various groups. The overall EFSs in childhood ALL improved in 1980s, but it seemed stable or decreased in 1990s. The short maintenance therapy resulted in poor outcome in SR on the L92-13 protocol. Many of these late relapsers were effectively rescued and overall survival remained at a high level. The proportion of patients who received cranial irradiation reduced without any increase of the CNS events.     

Improved survival of children with isolated CNS relapse of acute lymphoblastic leukemia: a pediatric oncology group study .

PURPOSE: Isolated meningeal relapse in children with acute lymphoblastic leukemia (ALL) usually has been followed by bone marrow relapse and limited survival. The purpose of this study was to prevent marrow relapse by administering intensive therapy before delayed craniospinal radiation. PATIENTS AND METHODS: Eighty-three patients with ALL in first bone marrow remission with an isolated CNS relapse were treated with systemic chemotherapy known to enter into the CSF and intrathecal chemotherapy for 6 months. Craniospinal irradiation (24 Gy cranial/15 Gy spinal) was then administered, followed by 1.5 years of maintenance chemotherapy. RESULTS: All 83 patients achieved a second remission. The 4-year event-free survival (EFS) rate was 71.1% +/- 5.3%. There was a fourfold increased risk of relapse for children whose initial remission was less than 18 months. The 4-year EFS rate for patients with a first complete remission >/= 18 months was 83.3% +/- 5.3%, and for those with a first complete remission less than 18 months, it was 46.2% +/- 10.2% (P =.0002.) There was a low incidence of neurologic toxicity and an unexpectedly high rate of allergic reactions to L-asparaginase. Five patients developed secondary malignancies: two with acute nonlymphoblastic leukemia during therapy, one with myelodysplasia after therapy, and two with brain tumors 1.5 to 2 years after cessation of therapy. CONCLUSION: For children with ALL and an isolated CNS relapse, treatment that delays definitive craniospinal irradiation by 6 months to allow for more intensive systemic and intrathecal chemotherapy results in better EFS than has been previously reported. Using this approach, the long-term prognosis for children with first complete remission >/= 18 months is comparable to that at the time of original diagnosis of ALL.     

Six months of maintenance chemotherapy after intensified treatment for acute lymphoblastic leukemia of childhood.

PURPOSE: We postulated that intensification of chemotherapy immediately after remission induction might reduce the leukemic cell burden sufficiently to allow an abbreviated period of antimetabolite therapy. PATIENTS AND METHODS: Three hundred forty-seven children (ages 1 to 15 years) with previously untreated acute lymphoblastic leukemia (ALL) were enrolled onto the Tokyo L92-13 study, which excluded patients with mature B-cell ALL and patients less than 1 year old. One hundred twenty-four patients were classified as standard risk, 122 as high risk, and 101 as extremely high risk, according to age, peripheral-blood leukocyte count, selected genetic abnormalities, and immunophenotype. All subjects received four drugs for remission induction, followed by a risk-directed multidrug intensification phase and therapy for presymptomatic leukemia in the CNS. Maintenance chemotherapy with oral mercaptopurine and methotrexate was administered for 6 months, with all treatment stopped by 1 year after diagnosis. RESULTS: The mean (+/- SD) event-free survival (EFS) and overall survival rates for all patients were 59.5% +/- 3.4% and 81.5% +/- 2.2%, respectively, at 5. 5 years after diagnosis. EFS rates by risk category were similar (60. 2% +/- 6.0% for standard risk, 57.7% +/- 5.6% for high risk, and 62. 5% +/- 5.7% for extremely high risk), whereas overall survival rates differed significantly (91.2% +/- 2.7%, 80.0% +/- 4.1%, and 72.1% +/- 4.5%, respectively, P <.0001 by the log-rank test). There were 107 relapses. Eighty-five (79.4%) of these 107 patients achieved second complete remissions, with subsequent EFS rates of 61.5% +/- 7. 9% (standard risk), 42.6% +/- 8.1% (high risk), and 9.6% +/- 6.4% (extremely high risk). Of the five risk factors analyzed, only the response to prednisolone monotherapy among extremely high-risk patients proved important. CONCLUSION: Early treatment intensification did not compensate for a truncated phase of maintenance chemotherapy in children with standard- or high-risk ALL. However, 6 months of antimetabolite treatment seemed adequate for extremely high-risk patients who were good responders to prednisolone and received intensified chemotherapy that included high-dose cytarabine early in the clinical course.     

Outcome of children treated for relapsed acute lymphoblastic leukemia in Central America

BACKGROUND:

Outcomes for relapsed childhood acute lymphoblastic leukemia (ALL) have not been documented in resource‐limited settings. This study examined survival after relapse for children with ALL in Central America.

METHODS:

A retrospective cohort study was performed and included children with first relapse of ALL in Guatemala, Honduras, or El Salvador between 1990 and 2011. Predictors of subsequent event‐free survival (EFS) and overall survival (OS) were examined.

RESULTS:

There were 755 children identified with relapsed disease. The median time from diagnosis to relapse was 1.7 years (interquartile range, 0.8‐3.1 years). Most relapses occurred during (53.9%) or following (24.9%) maintenance chemotherapy, and the majority occurred in the bone marrow (63.1%). Following the initial relapse, subsequent 3‐year EFS (± standard error) and OS were 22.0% ± 1.7%, and 28.2% ± 1.9%, respectively. In multivariable analysis, worse postrelapse survival was associated with age ≥ 10 years, white blood cell count ≥ 50 × 10⁹/L, and positive central nervous system status at the original ALL diagnosis, relapse that was not isolated central nervous system or testicular, and relapse < 36 months following diagnosis. Site and time to relapse were used to identify a favorable risk group whose 3‐year EFS and OS were 50.0% ± 8.9% and 68.0% ± 8.1%, respectively.

CONCLUSIONS:

Prognosis after relapsed ALL in Central America is poor, but a substantial number of those with favorable risk features have prolonged survival, despite lack of access to stem cell transplantation. Stratification by risk factors can guide therapeutic decision‐making. Cancer 2013. © 2012 American Cancer Society.     

Association between obesity at diagnosis and weight change during induction and survival in pediatric acute lymphoblastic leukemia

For children with acute lymphoblastic leukemia (ALL), the impact of obesity at diagnosis and weight change during induction on survival is uncertain. Objectives of this study were to describe the relationship between obesity and weight change during induction and event-free survival (EFS) and overall survival (OS). Participants were children 2-18 years old with ALL diagnosed between January 2001 and September 2006. Univariate and multiple regression analyses were conducted. In total 238 children were included; 21 (8.8%) were obese at diagnosis. Obese patients, compared with non-obese patients, had lower 5-year EFS (62.2±12.1% vs. 83.6±2.6%; p =0.02) and OS (80.7±8.7% vs. 92.9±1.9%; p =0.005). In univariate analysis, weight gain during induction was associated with better EFS (hazard ratio [HR] =0.89, 95% confidence interval [CI] 0.82-0.97; p =0.009) and OS (HR =0.81, 95% CI 0.74-0.90; p <0.0001). Obese pediatric patients with ALL have inferior survival while increased weight during induction may be associated with better survival. Causes of weight loss during induction should be aggressively managed.     

Poor treatment outcome of Philadelphia chromosome-positive pediatric acute lymphoblastic leukemia despite intensive chemotherapy

Children with Philadelphia (Ph) chromosome positive (+) acute lymphoblastic leukemia (ALL) represent a subgroup at very high risk for treatment failure. This study included 1322 children enrolled between 1988 and 1994 on CCG risk-adjusted studies for ALL who had centrally reviewed cytogenetic data. Thirty patients had a t(9;22) and are referred to as Ph+; 1292 were Ph-. 23 of these 30 patients were treated on the CCG-1882 high risk ALL protocol. The event-free survival (EFS) outcome in CCG-1882 was significantly worse for Ph+ compared with Ph- patients, with 4-year estimates of 11.3% (SD = 9.8%) and 73.4% (SD = 2.3%), respectively (p < 0.0001).     

TEL-AML1 fusion identifies a subset of children with standard risk acute lymphoblastic leukemia who have an excellent prognosis when treated with therapy that includes a single delayed intensification.

The Children's Cancer Group (CCG) found that children with moderate risk acute lymphoblastic leukemia (ALL) had an improved 5-year event-free survival (EFS) rate when treated with therapy that included a doubled delayed intensification (DDI) vs a single DI (SDI) phase. Because of increased toxicity with DDI, it is important to determine whether subgroups of children with ALL can be identified who have excellent outcomes with SDI therapy. TEL-AML1 fusion and hyperdiploid DNA content are present in the leukemic blasts of significant proportions of children with ALL and have been associated with an excellent prognosis. In this study, we retrospectively examined the impact of TEL-AML1 status and ploidy on treatment outcome in a cohort of 75 children with standard risk ALL treated at our institution between 1983 and 1993 with SDI therapy. TEL-AML1 fusion was present in 19/43 (44%) evaluable cases. Fifteen of 56 (27%) evaluable cases were classified as hyperdiploid based on a modal chromosome number of >/=51 and/or a DNA index of >/=1.16. The 7-year EFS was 81% for the 19 TEL-AML1-positive patients vs 54% for the 24 TEL-AML1-negative patients (P = 0.0264). In multivariate analyses, TEL-AML1-positive status was associated with a superior EFS (P = 0.02) even when the intial white blood count was included in the model. Overall survival (OS) at 7 years for TEL-AML1-positive patients was 100% vs 83% for TEL-AML1-negative patients (P = 0.0677). There were no differences in 7-year EFS or OS based on ploidy comparisons. These results underscore the need to examine closely the effects of treatment intensification on specific biologically defined subgroups of children with ALL.     

New agents for the treatment of patients with acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) has a bimodal age distribution with a peak occurring during early childhood and a second peak after age 45. Although all patients are treated with similar intensive chemotherapy regimens, good outcomes have occurred more frequently in children than adults. Most children with ALL have been able to achieve a complete remission (CR) with an induction rate of about 98% and a 5-year estimated event-free survival rate (EFS) rate of about 80%. Unfortunately, the results for adults are less encouraging. Current adult treatment regimens result in CR rates approaching 80%, with EFS at 5 years of only 30% to 40%. Regardless of age, patients with relapsed or refractory ALL have extremely poor outcomes, because CR rates are low and seldom durable. Clearly, new agents are required to improve the outcome of patients with relapsed or refractory ALL.