Date: 1/29/10
Author: Chessells
Journal: Arch Dis Child
Year: 2000
Pages: 438-432
Discussion:
Leukemia is a clonal disease resulting from genetic mutations and transformation of a single early progenitor myeloid or lymphoid cell. Despite much research limited understanding of the exact cause is known.
ALL: Over 95 percent of children with ALL achieve remission after three to four weeks of treatment with oral steroids, , weekly IV vincristine and a third drug L-Asparaginase.. If chemotherapy is performed within the first 8 - 10 months from diagnosis, it significantly reduces relapse.
AML: These patients require intense hospital based chemotherapy which produces bone marrow suppression. A therapy that requires upto five courses of treatment and a bone marrow transplant has increased survival rates upwards of 48 percent at seven years.
Relapse: 30 percent with ALL and 45 percent with AML relapse. Those that relapse after the first few months of remission have a good chance at achieving a second remission. If they relapse after two years the chance of cure is almost impossible.
Conclusions: There have been significant improvement in the outlook for children with acute leukemia. There is still room for improvement with conventional chemotherapy and the need for randomized trials. New treatment is needed for relapsed patients due to poor prognosis.
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