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Acute Lymphoblastic Leukemia in Infants: A Distinctive, High-Risk Subtype of Childhood Acute Lymphoblastic Leukemia

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Clinical Management of Acute Lymphoblastic Leukemia

Abstract

Acute lymphoblastic leukemia (ALL) in infants younger than 1 year of age is an aggressive, high-risk subtype of childhood ALL. Rearrangement of the KMT2A gene (KMT2A-r) on chromosome band 11q23 is a defining cytogenetic feature that occurs in approximately 80% of infants with ALL and is associated with poor prognosis for long-term remission and survival. Infant ALL with KMT2A-r is characteristically poorly responsive to chemotherapy and hematopoietic stem cell transplantation. New strategies, such as molecularly targeted therapies and immunotherapies, are in development and show promise in preclinical models and early phase studies. In this chapter, we discuss the unique biological features of ALL in infants, provide a historical overview of the clinical trials and outcomes for infants with ALL, and offer insight into the novel treatment approaches in development.

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Authors and Affiliations

  1. Department of Pediatrics, University of Cincinnati College of Medicine, Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Erin H. Breese

  2. Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children’s Hospital, Perth, WA, Australia

    Rishi S. Kotecha

  3. Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia

    Rishi S. Kotecha

  4. Curtin Medical School, Curtin University, Perth, WA, Australia

    Rishi S. Kotecha

  5. University of Missouri-Kansas City, Division of Pediatric Hematology/Oncology/Blood and Marrow Transplantation, Children’s Mercy Kansas City, Kansas City, MO, USA

    Erin M. Guest

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  1. Erin H. Breese
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  1. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    Mark R. Litzow

  2. Department of Pediatrics, NYU Langone Health, New York, NY, USA

    Elizabeth A. Raetz

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Breese, E.H., Kotecha, R.S., Guest, E.M. (2022). Acute Lymphoblastic Leukemia in Infants: A Distinctive, High-Risk Subtype of Childhood Acute Lymphoblastic Leukemia. In: Litzow, M.R., Raetz, E.A. (eds) Clinical Management of Acute Lymphoblastic Leukemia. Springer, Cham. https://doi.org/10.1007/978-3-030-85147-7_6

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