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Can relapse in acute lymphoblastic leukaemia (ALL) be prevented?

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Introduction

Can relapse in acute lymphoblastic leukaemia (ALL) be prevented? Acute Lymphoblastic Leukemia (ALL): Leukemia is cancer of the bone marrow, affecting the cells that produce white blood cells. The cause is not yet known, but it is understood that leukemia starts when one cell acquires a defect its gene and begins to grow and divide uncontrollably. Leukemia falls under four sub-categories that refer to the type of white blood cell they affect. 1,2,12 White blood cells are made in the bone marrow, the soft inner part of the bone, starting as stem cells and are produced as they are needed. In ALL the bone marrow produces too many white blood cells called lymphocytes, they are not fully developed and do not work properly. The diagram shows how the stages of development, from stem cells to mature lymphocytes. 1, 2, 12 In a health person the amount of immature morrow lies at 1-2%, in a leukemia patient it is usually between 40-90%.13 The large amount of abnormal, immature white blood cells (B-lymphocytes and T-lymphocytes), means that the body is more prone to infection, and healthy red blood cells and platelets cannot be produced. The abnormal cells can get into the blood stream and can accumulate in the lymph nodes, and spleen, affecting the liver, spinal cord and/or brain. 12, 14 Acute Lymphoblastic Leukemia is one of the few cancers that are most common amongst children. 85% of ALL cases arise in children and only round 200 adults in the UK are affected. It is also the most common cancer within pediatrics, with 1/3 of all childhood cancer cases being leukemia. 13 Due to developments in research, cure rates have risen from incurable in the 1960's, to 85% cure in children and 50% in adults. 4 Symptoms: 2, 14 Symptoms can be hard to identify as they also indicate different illnesses. Some of the symptoms include... ...read more.

Middle

These children were part of a multicenter, randomized clinical trial, which, in the second year of treatment, compared a 2-month reinduction -reintensification therapy followed by maintenance chemotherapy with standard maintenance chemotherapy alone. MRD was detected in 69% of patients at 1 month, 25% at 12 months, and 28% at 24 months from when first diagnosed. Through result analysis, high levels of MRD at 1 month, or the presence of any detectable MRD at 12 or 24 months from diagnosis, were highly predictive of relapse. Results showed, MRD testing at 1 and 24 months each had independent prognostic significance. Intensified therapy at 12 months from diagnosis did not improve prognosis in those patients who were MRD positive at 12 months diagnosis. The graph to the left helps show the results. Clinical outcome in childhood ALL can be predicted with high accuracy by combining the results of MRD testing at 1 and 24 months from diagnosis. "Regular testing even after the patient achieves induced remission, will significantly lower the rate at which relapse is currently occurring." This therefore proves that testing for MRD within the patient throughout treatment and remission will allow the doctor to adapt treatment for suitable levels for the patient and successfully predict the likeliness of relapse, and best way of prevention. The second study looked at the clinical significance of MRD in childhood Acute Lymphoblastic Leukemia. This study investigated the significance of MRD in childhood acute lymphoblastic leukemia, looking closely at links and patterns that may arise between different patients. Currently the connection and effect of residual disease after treatment of ALL is unclear. The Berlin-Frankfurt-Munster (BFM) treatment protocol was used, with minor modifications. Sequences of T-cell-receptor or immunoglobulin gene rearrangements (IG) were used as leukemic cell markers. Residual disease was measured using polymerase chain reaction assay. A total of 246 children with ALL were enrolled in the study at the time of diagnosis, starting July 1993 and ending March 1996. ...read more.

Conclusion

as well as, or instead of, PCR. Radiotherapy| treats cancer by using high-energy rays to destroy the cancer cells with as little harm to normal cells as possible. PCR aims these high-energy x-rays at the head through a radiotherapy machine. PCR is given as a series of short daily treatments in the radiotherapy department, using equipment similar to a large x-ray machine. Each treatment lasts for only a few minutes, the number of sessions vary depending upon each patient's situation. 2. Bone marrow or stem cell transplant - the replacement of healthy stem cells, allowing you body to produce normal, un-cancerous cells. Bone marrow and stem cell transplants for ALL are intensive treatments. Intensive treatment is high dose chemotherapy, and sometimes total body radiotherapy. This treatment kills off all your bone marrow, containing the stem cells that make blood cells. The stem cells need to be replaced for the patient to survive treatment. You have the stem cells replaced by a drip of... * Someone else's bone marrow or stem cells * Your own bone marrow * Your own stem cells, although this is very uncommon (Illustrated in the diagram to the right) The choice between a donor transplant and having your own bone marrow or stem cells depends on a number of different factors, including the type of leukemia and whether a member of family's blood closely matches the patients. Healthy marrow or stem cells collected and frozen until high dose chemo and radiotherapy are administered. They are then defrosted and given through a central line. The cells find their own way to the centre of your bones. They begin to make blood cells after a few days or weeks. Because of risk of infection, the patient must stay in isolation until the marrow or stem cells have started to make new blood cells again. Bibliography: E.g. Title - Date of last Access Author Source (Web Address/ Journal) 1. Patient UK - 01/04/10 Multiple authors; certified by information standards. (References Pui CH, Robison LL, Look AT, Crazzolara R, Bendall L, Belson M, Kingsley B, Holmes A) http://www.patient.co.uk/health/Leukaemia-Acute-Lymphoblastic.htm 2. ...read more.

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