Acute lymphoblastic leukemia (ALL) is the second most common acute leukemia in adults, with an incidence of over cases per year in the United States. Leukemia limfoblastik akut (LLA) pada anak merupakan penyakit yang heterogen. pasien dengan fusi gena TEL-AML1, BCR-ABL, E2A-PBX1 adalah sama. Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells (February ). "Secondary Leukemia or Myelodysplastic Syndrome After Treatment With Epipodophyllotoxins" (PDF). Journal of Clinical Oncology. 17 (2).
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PDF | Acute leukemia is the most common form of cancer in children, comprises Perbedaan Kesintasan 5 tahun Pasien Leukemia Limfoblastik Akut dan. 5 hari yang lalu Leukemia limfoblastik akut (LLA) adalah penyakit keganasan yang paling sering didiagnosis pada anak-anak. Penilaian prognosis leukemia. Acute lymphoblastic leukemia (ALL) is a malignant proliferation of lymphoid cells blocked at December echecs16.info
Patofisiologi dan Diagnosis Infiltrasi Leukemia Limfoblastik Akut ke Sistem Saraf Pusat Tika Adilistya Abstract Leukemia limfoblastik akut LLA adalah keganasan hematologi yang disebabkan oleh proliferasi prekursor sel limfoid yang menyebabkan akumulasi sel blas di darah tepi dan sumsum tulang. Berbagai kemajuan dalam terapi, seperti targeted therapy, telah berhasil menurunkan angka kematian pasien dengan LLA. Pasien dengan keterlibatan SSP seringkali underdiagnosed baik secara klinis maupun laboratoris. Peranan laboratorium sangat penting untuk deteksi keterlibatan SSP mengingat sulitnya gejala klinis tidak khas bahkan sebagian pasien justru asimtomatis. Dengan adanya deteksi dini, pasien dapat diberikan terapi profilaksis sehingga angka kesintasan meningkat. Pemeriksaan lain seperti immunophenotyping flow cytometry FCM dan polymerase chain reaction PCR memiliki nilai diagnostik yang dua kali lipat lebih baik apabila digunakan secara kombinasi dengan sitologi, namun tidak dapat menggantikan peran pemeriksaan sitologi.
The median response duration and the overall survival were 9 and 6 months, respectively. The most frequent adverse events include fever, chills, neutropenia, anemia and hypogammaglobulinemia.
However, owing to different biology of the two subtypes, T-cell ALL is not amenable to salvage treatment with blinatumomab. Fortunately, alternative options for salvage therapy exist.
Nelarabine accumulates in T cells at a high rate and incorporates into DNA causing an inhibition of DNA synthesis and subsequent apoptosis. Cycles were repeated every 22 days. Epratuzumab was evaluated in 15 pediatric patients as part of a salvage therapy regimen. The antibody was administered as a single-agent followed by the antibody in combination with standard re-induction chemotherapy.
The treatment resulted in a CR in 9 of the patients, with 7 achieving complete MRD clearance at the end of re-induction.
Preclinical studies showed that calicheamicin conjugated to an anti-CD22 antibody resulted in potent cytotoxicity leading to regression of B-cell lymphoma and prevention of xenograft establishment at picomolar concentrations. Cumulative doses were equivalent among the two treatment strategies. Median survival was 6. However, toxicity was greatly improved by weekly dosing, with a significant reduction in fever, hepatotoxicity and veno-occlusive disease.
The rate of complete remission was significantly higher in the InO group versus standard chemotherapy The most common adverse events of InO treatment included thrombocytopenia and neutropenia. In attempt to reduce toxicity, doxorubicin was eliminated from induction therapy, and cyclophosphamide, prednisone, methotrexate and cytarabine were given at reduced doses.
InO was given during each of the first four courses. Moxetumomab is a reformulation of an older study drug, BL22, which was composed the variable region Fv of an anti-CD22 monoclonal antibody fused to Pseudomonas aeruginosa exotoxin A. B-CD20 CD20 is a B-lineage specific antigen expressed at nearly all stages of differentiation on the surface of both normal and malignant B-cells. Signaling through CD20 plays a role in cell cycle progression, differentiation pathways and regulation of apoptosis.
The addition of rituximab, a first-generation anti-CD20 monoclonal antibody, has improved outcomes in these patients, but resistance to rituximab represents a limitation to its use. Ofatumumab Ofatumumab is a second-generation anti-CD20 antibody with a distinct binding site from that of rituximab. Ofatumumab was first showed to have benefit in fludarabine-refractory chronic lymphocytic leukemia, irrespective of prior rituximab exposure.
However, obinutuzumab induced direct cell death and ADCC more rapidly and effectively. When all three mechanisms of cell death were evaluated together in B-cell depletion assays, obinutuzumab was more effective than either rituximab or ofatumumab achieving higher maximal depletion and lower EC Furthermore, obinutuzumab was superior in inhibiting growth in NHL xenograft models.
In a pre-B-ALL xenograft model, overall survival was improved with obinutuzumab compared to ritixumab. The theory of REGN is similar to that of blinatumumab, to engage T cells and B-cells thus resulting in activation of T-cell immune response against B-cells.
REGN prevented the establishment of lymphoma xenografts and led to complete tumor regression in murine models. When compared to treatment with rituximab, treatment with REGN led to significantly more profound depletion of B-cells. Dose-dependent antitumor activity was observed. The most significant adverse events include cytokine release syndrome CRS and hypotension. C-CD19 CD19 is the most widely expressed B-lineage specific antigen, expressed during all stages of differentiation, but lost on maturation to plasma cells.
CD19 serves as a co-receptor for the B-cell surface immunoglobulin and its activation triggers a phosphorylation cascade involving src-family kinases and PI3K as well as the activation of c-myc, leading to proliferation and differentiation.
Maytansinoids are more potent than vinca alkaloids, and thus have been of limited use in systemic therapy due to unacceptable toxicity.
When used in combination with a chemotherapy regimen that mimicked pediatric induction protocols, SAR was effective at prolonging the duration of remission. Dose-limiting toxicities were reversible blurred vision and neuropathy. In this case, the antibody is linked to the microtubule-disrupting agent monomethyl auristatin F MMAF.
It is a humanized monoclonal antibody conjugated to a pyrrolobenzodiazepine PBD. PBDs are a class of natural antibiotics derived from actinomycetes bacteria that inhibit cell division by binding in the minor groove of DNA and cross-linking strands of DNA.
In vivo studies show superior antitumor activity of ADCT against CDpositive lymphoma than maytansinoid or auristatin based therapy. IL-2 R is rapidly recycled upon binding of its ligand.
In preclinical studies, ADCT has been shown to be potently cytotoxic to CDpositive anaplastic large cell lymphoma and Hodgkin lymphoma cell lines. In vivo, ADCT exhibited antitumor activity in xenograft and disseminated mouse models. Preclinical studies have suggested a synergistic role of bortezomib with dexamethasone and additive effects to standard chemotherapy agents in acute leukemias.
It has long been reported that DNA methylation may play a role in the development of ALL and that methylation status may be used as part of risk stratification. This leads to differentiation and suppression of tumor growth.
In a case report, a young girl with her third-relapse of ALL was treated with a decitabine and dexamethasone regimen based on MDS dosing.
More recently, fourth-generation CAR-Ts have been engineered to include a cytokine-expressing cassette. The process of CAR T-cell therapy involves collecting T cells, introducing the CAR construct, and then an autologous transplant of the modified T cells back into the patient. Options for gene delivery methods include viral vectors and RNA-based methods.
Theoretic risks of this method include malignant transformation of the engineered T cells if the CAR construct is inserted in such a way that it deregulates the expression of an oncogene.
Given the high replicative potential of these T cells, this methods also offers the advantage of a profound antitumor response.
Several studies have identified lower rates of ALL among children with greater exposure to illness early in life. Very young children who attend daycare have lower rates of ALL. Evidence from many other studies looking at disease exposure and ALL is inconclusive. These changes include chromosomal translocations , intrachromosomal rearrangements , changes in the number of chromosomes in leukemic cells, and additional mutations in individual genes. This move can result in placing a gene from one chromosome that promotes cell division to a more actively transcribed area on another chromosome.
The result is a cell that divides more often. An example of this includes the translocation of C-MYC , a gene that encodes a transcription factor that leads to increased cell division, next to the immunoglobulin heavy - or light-chain gene enhancers , leading to increased C-MYC expression and increased cell division.
The result is the combination of two usually separate proteins into a new fusion protein. This protein can have a new function that promotes the development of cancer. These mutations produce a cell that divides more often, even in the absence of growth factors.
Gaining at least five additional chromosomes, called high hyperdiploidy, occurs more commonly. Less often, chromosomes are lost, called hypodiploidy , which is associated with a poorer prognosis. In childhood ALL, for example, one fusion gene translocation is often found along with six to eight other ALL-related genetic changes.
These lymphoblasts build up in the bone marrow and may spread to other sites in the body, such as lymph nodes , the mediastinum , the spleen , the testicles , and the brain , leading to the common symptoms of disease. While many symptoms of ALL can be found in common illnesses, persistent or unexplained symptoms raise suspicion of cancer.
Because many features on the medical history and exam are not specific to ALL, further testing is often needed. A large number of white blood cells and lymphoblasts in the circulating blood can be suspicious for ALL because they indicate a rapid production of lymphoid cells in the marrow. The higher these numbers typically points to a worse prognosis.
Brain and spinal column involvement can be diagnosed either through confirmation of leukemic cells in the lumbar puncture or through clinical signs of CNS leukemia as described above. Laboratory tests that might show abnormalities include blood count, kidney function, electrolyte, and liver enzyme tests. Cytogenetic testing on the marrow samples can help classify disease and predict how aggressive the disease course will be.