Çocukluk Çağında Akut Lenfoblastik Lösemi

Öz

Çocukluk çağı kanserlerinin %25-30’unu lösemiler oluştururken, lösemilerin yaklaşık %97’sinden akut lösemiler sorumludur. On beş yaşından küçük çocuklarda akut lenfoblastik lösemi, akut myeloblastik lösemiye göre yaklaşık beş kat daha sık görülmektedir. Akut lenfoblastik lösemilerin Türkiye’de yıllık insidansı 1.5/100.000’dir. Akut lenfoblastik lösemide tedaviye yanıt ve sağ kalım oranları 1960’lı yıllarda %10 düzeyine ulaşmaz iken, bugün tedavi protokolleri ile hastaların yaklaşık olarak %80-90’ında remisyon sağlanabilmektedir. Yüksek riskli hastaların tedavisinde daha fazla ajan daha yüksek dozlarda ve daha uzun süre verilmektedir. Uygun vakalarda kök hücre nakli yapılmaktadır.

Anahtar Kelimeler

• Lenfositik lösemi,Epidemiyoloji,Sınıflandırma,Prognoz

Acute Lymphoblastic Leukemia in Childhood

Abstract

While leukemia is responsible for 25-30% of childhood cancers, acute leukemia accounts for about 97% of leukemia. In children younger than 15 years, Acute lymphoblastic leukemia is about five times more common than acute myeloid leukemia. The annual incidence of acute lymphoblastic leukemia in Turkey is 1.5/100,000. While treatment response and survival rates in acute lymphoblastic leukemia did not reach 10% in 1960s, approximately 80-90% of patients can be remitted with treatment protocols today. In the treatment of high-risk patients, more agents are given at higher doses and for longer periods. In appropriate cases, stem cells are transplanted.

Keywords

• Epidemiology,Classification,lymphoblastic leukemia

Kaynakça

1. Rabin KR, Gramatges MM, Margolin JF, Poplack DG. Acute Lymphoblastic Leukemia. In: Pizzo PA and Poplack DG, Eds. Principles and Practice of Pediatric Oncology, 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2015:463-497.
2. Celkan T. Çocukluk çağı akut lenfoblastik lösemisi. Klinik Gelişim Dergisi 2007; 20 (2): 14-25.
3. Hrusák O, Trka J, Zuna J, Poloucková A, Kalina T, Starý J; Czech Pediatric Hematology Working Group. Acute lymphoblastic leukemia incidence during socioeconomic transition: selective increase in children from 1 to 4 years. Leukemia 2002;16 (4):720–725.
4. Soycan YL. [Acute lymphoblastic leukemia; diagnosis, clinical] in Pediatric Hematology 1. Baskı, İstanbul medikal yayıncılık, Anak S, İstanbul, Türkiye, 1.baskı, 2011;597-607.
5. Pui CH, Relling MV, Downing JR. Acute lymphoblastic leukemia. N Engl J Med 2004;350 (15):1535–1548.
6. Brown P, Hunger SP. Acute leukemia in children. In: Bope ET, Rakel RE, Kellerman RD, eds. Conn’s current therapy. Philadelphia, PA: Saunders, 2013:765–768.
7. Caughey RW, Michels KB. Birth weight and childhood leukemia: a meta-analysis and review of the current evidence. Int J Cancer 2009;124 (11):2658–2670.
8. Martin RM, Gunnell D, Owen CG, Smith GD. Breast-feeding and childhood cancer: a systematic review with metaanalysis. Int J Cancer 2005;117(6):1020–1031.

9. Lee KM, Ward MH, Han S, Ahn HS, Kang HJ, Choi HS, et al. Paternal smoking, genetic polymorphisms in CYP1A1and childhood leukemia risk. Leuk Res 2009;33(2):250–258.
10. Moloney WC. Leukemia in survivors of atomic bombing. N Engl J Med 1955;253(3):88–90.
11. Pui CH, Robison LL, Look AT. Acute lymphoblastic leukaemia. Lancet 2008;371:1030–1043.
12. Zwaan MC, Reinhardt D, Hitzler J, Vyas P. Acute leukemias in children with Down syndrome. Pediatr Clin North Am 2008;55(1):53–70.
13. Greaves MF, Maia AT, Wiemels JL, Ford AM. Leukemia in twins: lessons in natural history. Blood 2003;102(7):2321–2333.
14. McClain KL, Leach CT, Jenson HB, Joshi VV, Pollock BH, Parmley RT et al. Association of Epstein-Barr virus with leiomyosarcomas in children with AIDS. N Engl J Med 1995;332(1):12–18.
15. Metayer C, Zhang L, Wiemels JL, Bartley K, Schiffman J, Ma X, et al. Tobacco smoke exposure and the risk of childhood acute lymphoblastic and myeloid leukemias by cytogenetic subtype. Cancer Epidemiol Biomarkers Prev 2013;22(9):1600–1611.
16. Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon, France: IARC, 2008.
17. Dastugue N, Suciu S, Plat G, Speleman F, Cave H, Girard S, et al. Hyperdiploidy with 58-66 chromosomes in childhood B-acute lymphoblastic leukemia is highly curable: 58951 CLG-EORTC results. Blood 2013;121(13):2415–2423.
18. Moorman AV, Richards SM, Martineau M, Cheung KL, Robinson HM, Jalali GR, et al. Outcome heterogeneity in childhood high-hyperdiploid acute lymphoblastic leukemia. Blood. 2003; 102(8): 2756-62.
19. Kato M, Imamura T, Manabe A, Hashii Y, Koh K, Sato A et al. Prognostic impact of gained chromosomes in high-hyperdiploid childhood acute lymphoblastic leukaemia: a collaborative retrospective study of the Tokyo Children's Cancer Study Group and Japan Association of Childhood Leukaemia Study. Br J Haematol. 2014; 166(2): 295-8.
20. Nachman JB, Heerema NA, Sather H, Camitta B, Forestier E, Harrison CJ, et al. Outcome of treatment in children with hypodiploid acute lymphoblastic leukemia. Blood. 2007; 110: 1112-5.
21. Mullighan CG. Genome sequencing of lymphoid malignancies. Blood 2013;122 (24):3899–3907.
22. Heerema NA, Sather NH, Sensel MG, Zhang T, Hutchinson RJ, Nachman JB, et al. Prognostic impact of trisomies 10, and 5 among children with acute lymphoblastic leukaemia and high hyperdiploidy (>50 chromosomes). J Clin Oncol 2000;18(9):1876–87.
23. Sutcliffe MJ, Shuster JJ, Sather HN, Camitta BM, Pullen J, Schultz KR, et al. High concordance from independent studies by the Children's Cancer Group (CCG) and Pediatric Oncology Group (POG) associating favorable prognosis with combined trisomies 4, 10, and 17 in children with NCI Standard-Risk B-precursor Acute Lymphoblastic Leukemia: a Children's Oncology Group (COG) initiative. Leukemia. 2005; 19(5): 734-40.
24. Bhojwani D, Pei D, Sandlund JT, Jeha S, Ribeiro RC, Rubnitz JE et al. ETV6-RUNX1-positive childhood acute lymphoblastic leukemia: improved outcome with contemporary therapy. Leukemia. 2012; 26(2): 265-70.
25. Jeha S, Pei D, Raimondi SC, Onciu M, Campana D, Cheng C, et al. Increased risk for CNS relapse in pre-B cell leukemia with the t(1;19)/TCF3-PBX1. Leukemia 2009;23 (8):1406–1409.
26. Yen HJ, Chen SH, Chang TY, Yanh CP, Lin DT, Hung IJ, et al. Pediatric acute lymphoblastic leukemia with t(1;19)/TCF3-PBX1 in Taiwan. Pediatr Blood Cancer. 2017; 64(10).
27. Arico M, Valsecchi MG, Camitta B, Schrappe M, Chessells J, Baruchel A, et al. Outcome of treatment in children with Philadelphia chromosome-positive acute lymphoblastic leukemia. N Engl J Med 2000;342 (14):998–1006.
28. Schultz KR, Carroll A, Heerema NA, Bowman WP, Aledo A, Slayton WB, et al. Long-term follow-up of imatinib in pediatric Philadelphia chromosome-positive acute lymphoblastic leukemia: Children’s Oncology Group Study AALL0031. Leukemia 2014;28 (7):1467–1471.
29. Biondi A, Schrappe M, De Lorenzo P, Castor A, Lucchini G, Gandemer V, et al. Imatinib after induction for treatment of children and adolescents with Philadelphia-chromosome-positive acute lymphoblastic leukaemia (EsPhALL): a randomised, open-label, intergroup study. Lancet Oncol. 2012; 13(9): 936-45.
30. Antony R, Roebuck D, Hann IM. Unusual presentations of acute lymphoid malignancy in children. J R Soc Med 2004;97 (3):125–127.
31. Kato M, Koh K, Kikuchi A, Toyama D, Mochizuki S, Uchisaka N, et al. Case series of pediatric acute leukemia without a peripheral blood abnormality, detected by magnetic resonance imaging. Int J Hematol. 2011; 93(6): 787-90.
32. Laningham FH, Kun LE, Reddick WE, Ogg RJ, Morris RB, Pui CH. Childhood central nervous system leukemia: historical perspectives, current therapy, and acute neurological sequelae. Neuroradiology 2007;49 (11):873–888.
33. Reismuller B, Attarbaschi A, Peters C, Dworzak MN, Pötschger U, Urban C, et al. Long-term outcome of initially homogenously treated and relapsed childhood acute lymphoblastic leukaemia in Austria–a population-based report of the Austrian Berlin-Frankfurt-Munster (BFM) Study Group. Br J Haematol 2009;144 (4):559–570.
34. Hastings C, Gaynon PS, Nachman JB, Sather HN, Lu X, Devidas M, et al. Increased post induction intensification improves outcome in children and adolescents with a markedly elevated white blood cell count (>200 × 109/L) with T cell Acute Lymphoblastic Leukemia but not B-cell disease: a report from the Children’s Oncology Group. Br J Haematol 2015; 168 (4):533-46.
35. Pieters R, Schrappe M, De Lorenzo P, Hann I, De Rossi G, Felice M, et al. A treatment protocol for infants younger than 1 year with acute lymphoblastic leukaemia (Interfant-99): an observational study and a multicentre randomised trial. Lancet 2007;370 (9583):240–250.
36. Co-Reyes E, Li R, Huh W, Chandra J. Malnutrition and obesity in pediatric oncology patients: causes, consequences, and interventions. Pediatr Blood Cancer 2012;59 (7):1160–1167.
37. Pui CH, Pei D, Raimondi SC, Coustan-Smith E, Jeha S, Cheng C, et al. Clinical impact of minimal residual disease in children with different subtypes of acute lymphoblastic leukemia treated with Response-Adapted therapy. Leukemia. 2017; 31(2): 333-9.
38. Campana D. Minimal residual disease monitoring in childhood acute lymphoblastic leukemia. Curr Opin Hematol 2012;19 (4):313–318.
39. Vora A, Goulden N, Mitchell C, Hancock J, Hough R, Rowntree C, et al. Augmented post-remission therapy for a minimal residual disease-defined high-risk subgroup of children and young people with clinical standard-risk and intermediate-risk acute lymphoblastic leukaemia (UKALL 2003): a randomised controlled trial. Lancet Oncol. 2014; 15(8): 809-18.
40. Hunger SP, Lu X, Devidas M, Camitta BM, Gaynon PS, Winick NJ, et al. Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children’s oncology group. J Clin Oncol 2012;30 (14):1663–1669.
41. Inaba H, Greaves M, Mullighan CG. Acute lymphoblastic leukaemia. Lancet. 2013; 381: 1943-55.
42. Moorman AV, Ensor HM, Richards SM, Chilton L, Schwab C, Kinsey SE, et al. Prognostic effect of chromosomal abnormalities in childhood B-cell precursor acute lymphoblastic leukaemia: results from the UK Medical Research Council ALL97/99 randomised trial. Lancet Oncol. 2010; 11(5): 429-38.
43. Pui CH, Campana D. New definition of remission in childhood acute lymphoblastic leukemia. Leukemia 2000;14 (5):783–785.
44. Teuffel O, Kuster SP, Hunger SP, Conter V, Hitzler J, Ethier MC, et al. Dexamethasone versus prednisone for induction therapy in childhood acute lymphoblastic leukemia: a systematic review and meta-analysis. Leukemia 2011;25 (8):1232–1238.
45. Kawedia JD, Liu C, Pei D, Cheng C, Fernandez CA, Howard SC, et al. Dexamethasone exposure and asparaginase antibodies affect relapse risk in acute lymphoblastic leukemia. Blood 2012;119 (7):1658–1664.
46. Vrooman LM, Stevenson KE, Supko JG, O’Brien J, Dahlberg SE, Asselin BL, et al. Postinduction dexamethasone and individualized dosing of Escherichia Coli L-asparaginase each improve outcome of children and adolescents with newly diagnosed acute lymphoblastic leukemia: results from a randomized study--Dana-Farber Cancer Institute ALL Consortium Protocol 00-01. J Clin Oncol. 2013; 31(9): 1202-10.
47. Kearney SL, Dahlberg SE, Levy DE, Voss SD, Sallan SE, Silverman LB. Clinical course and outcome in children with acute lymphoblastic leukemia and asparaginase-associated pancreatitis. Pediatr Blood Cancer 2009;53 (2):162–167.
48. Smith LA, Cornelius VR, Plummer CJ, Levitt G, Verrill M, Canney P, et al. Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials. BMC Cancer 2010;10:337.
49. Pui CH, Howard SC. Current management and challenges of malignant disease in the CNS in paediatric leukaemia. Lancet Oncol 2008;9 (3):257–268.
50. Pui CH, Campana D, Pei D, Bowman WP, Sandlund JT, Kaste SC, et al. Treating childhood acute lymphoblastic leukemia without cranial irradiation. N Engl J Med 2009;360 (26):2730–2741.
51. Mehta PA and Davies SM. Allogeneic transplantation for childhood ALL. Bone Marrow Transplant 2008; 41(2): 133-139.
52. Topp MS, Gökbuget N, Stein AS, Zugmaier G, O’Brien S, Bargou RC, et al. Safety and activity of blinatumomab for adult patients with relapsed or refractory B-precursor acute lymphoblastic leukaemia: a multicentre, single-arm, phase 2 study. Lancet Oncol. 2015; 16(1): 57-66.
53. Maude SL, Frey N, Shaw PA, Aplenc R, Barrett DM, Bunin NJ, et al. Chimeric antigen receptor T cells for sustained remissions in leukemia. N Engl J Med. 2014; 371(16): 1507-17.