Clinical Update
Advances in childhood leukaemia: successful clinical-trials research leads to individualised therapy
David S Ziegler MB BS,
Glenn M Marshall MB BS, FRACP,
Luciano Dalla Pozza MB BS, FRACP,
Keith D Waters MB BS, FRACP,
David S Ziegler MB BS
Fellow in Haematology and Oncology
Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, NSW.
Search for more papers by this authorGlenn M Marshall MB BS, FRACP
Director
Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, NSW.
Search for more papers by this authorLuciano Dalla Pozza MB BS, FRACP
Paediatric Oncologist
Oncology Unit, Children's Hospital at Westmead, Westmead, NSW.
Search for more papers by this authorKeith D Waters MB BS, FRACP
Consultant Haematologist
Department of Haematology and Oncology, Royal Children's Hospital, Melbourne, VIC.
Search for more papers by this authorDavid S Ziegler MB BS,
Glenn M Marshall MB BS, FRACP,
Luciano Dalla Pozza MB BS, FRACP,
Keith D Waters MB BS, FRACP,
David S Ziegler MB BS
Fellow in Haematology and Oncology
Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, NSW.
Search for more papers by this authorGlenn M Marshall MB BS, FRACP
Director
Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, NSW.
Search for more papers by this authorLuciano Dalla Pozza MB BS, FRACP
Paediatric Oncologist
Oncology Unit, Children's Hospital at Westmead, Westmead, NSW.
Search for more papers by this authorKeith D Waters MB BS, FRACP
Consultant Haematologist
Department of Haematology and Oncology, Royal Children's Hospital, Melbourne, VIC.
Search for more papers by this authorAbstract
- In most cases, childhood leukaemia has a fetal origin, but multiple molecular events are required after birth for pre-leukaemic cells to progress to leukaemia.
- Cure rates for acute lymphoblastic leukaemia (ALL) now approach 80%.
- A high level of minimal residual disease detected by polymerase chain reaction in patients with ALL in remission has profound prognostic importance and is the focus of a major Australian study attempting to prevent relapse in these children.
- Greater awareness of the late effects of chemotherapy has led to changes in the treatment protocols for ALL, with improvement in neurocognitive outcomes and reduced rates of second malignancies.
- Pharmacogenetics is a new field of research that aims to enhance treatment efficacy by assessing the individual's metabolism of and response to chemotherapeutic agents.
- Targeted therapies currently being developed show some promise of being able to further improve cure rates.
- Adolescents with ALL have a better prognosis if treated with paediatric rather than adult protocols.
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