Why is age such an important independent prognostic factor in acute lymphoblastic leukemia ?

Despite the use of similar intensive chemotherapy regimens, adults with acute lymphoblastic leukemia (ALL) exhibit a strikingly inferior outcome when compared to children. Mirroring this difference in prognosis, childhood and adult ALL exhibit distinctive age-related differences in potential etiolog...

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Bibliographic Details
Published inLeukemia Vol. 11; pp. S4 - S7
Main Author PERENTESIS, J. P
Format Conference Proceeding Journal Article
LanguageEnglish
Published London Nature Publishing 01.05.1997
Subjects
Adult
Age Factors
Biological and medical sciences
Child
Child, Preschool
Chromosomes, Human, Pair 12
Chromosomes, Human, Pair 21
Hematologic and hematopoietic diseases
Humans
Incidence
Karyotyping
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Medical sciences
Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology
Precursor Cell Lymphoblastic Leukemia-Lymphoma - genetics
Prognosis
Translocation, Genetic
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Summary:Despite the use of similar intensive chemotherapy regimens, adults with acute lymphoblastic leukemia (ALL) exhibit a strikingly inferior outcome when compared to children. Mirroring this difference in prognosis, childhood and adult ALL exhibit distinctive age-related differences in potential etiologic factors and underlying biology. Childhood ALL mostly occurs in industrialized countries, with a unique peak in incidence between the ages of 2 and 8 years. It is associated with features conferring a favorable response to therapy, including early pre-B cell disease and a hyperdiploid karyotype or a cryptic t(12;21) translocation. The lymphoblasts of childhood ALL appear to arise in a developmental compartment that is "poised" for apoptotic death and are particularly sensitive to glucocorticoids, antimetabolites, and other cytotoxic agents. In contrast, adult ALL commonly possesses the poor-prognosis Philadelphia chromosome and is often drug-resistant. A far higher proportion of adults with ALL present with high initial white blood cell count and high-risk immunophenotypes, and exhibit a slow induction of remission with greater therapy-related toxicity. Improved supportive care measures with current intensive therapies and the development of novel leukemia-targeted biotherapies will be required to improve the cure rates of adults with ALL.
ISSN:0887-6924
1476-5551