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Relapsed or Refractory Pediatric Acute Lymphoblastic Leukemia

Current and Emerging Treatments

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Abstract

Relapsed acute lymphoblastic leukemia (ALL) represents a major cause of morbidity and mortality in pediatrics. With contemporary chemotherapy, >85% of patients with newly diagnosed ALL survive. Unfortunately, 20% of these patients will relapse and for these children, outcomes remain poor despite our best known chemotherapy protocols. Most of these children will achieve a second complete remission, but maintaining this remission remains difficult. Because relapsed ALL is such a significant cause of morbidity and mortality, it is the focus of much research interest. Efforts have been made and continue to focus on understanding the underlying biology that drives relapse. The role of hematopoietic stem cell transplantation in relapsed ALL remains unclear, but many clinicians still favor this for high-risk patients given the poor prognosis with current chemotherapy alone.

It is important to use new drugs with little cross-resistance in the treatment of relapsed ALL. New classes of agents are currently being studied. We also discuss prognostic factors and the biology of relapsed ALL.

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Acknowledgments

We thank Drs Ken-ichi Arai and Kirk Schultz for their valuable comments on the TLR9 agonist. No sources of funding were used to assist in the preparation of this review. Dr Hijiya has received research funds from, and serves as a consultant to, Sanofi-Aventis. All other authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Division of Hematology/Oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago, Box#30, Chicago, Illinois, IL 60611, USA

    Alissa Martin, Elaine Morgan &  Nobuko Hijiya MD (Hematology)

  2. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    Elaine Morgan &  Nobuko Hijiya MD (Hematology)

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  1. Alissa Martin
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  2. Elaine Morgan
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  3. Nobuko Hijiya MD
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Correspondence to Nobuko Hijiya MD.

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Martin, A., Morgan, E. & Hijiya, N. Relapsed or Refractory Pediatric Acute Lymphoblastic Leukemia. Pediatr Drugs 14, 377–387 (2012). https://doi.org/10.1007/BF03262418

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