Recommendations of the European Working Group for Adult ALL / UNI-MED Science (PDF)
(Sprache: Englisch)
Acute lymphoblastic leukemia (ALL) is a malignant disease of lymphatic cells in the bone marrow or other organs of the lymphoid system with a number of unique features. Cure rates were improved in the past decades first in children and later in adults from...
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Acute lymphoblastic leukemia (ALL) is a malignant disease of lymphatic cells in the bone marrow or other organs of the lymphoid system with a number of unique features. Cure rates were improved in the past decades first in children and later in adults from less than 10% to 40-50% and even >50% in distinct subgroups. Important progress was also achieved in basic research, particularly in molecular genetics. The progress in terms of diagnosis and treatment of ALL has stemmed mainly from systematic clinical research by a number of cooperative study groups. It is based on optimisation of chemotherapy, stem cell transplantation, supportive care integrated in risk adapted treatment strategies and more recently complemented by approaches for targeted therapy.
The book gives an overview on the current strategies for ma-nagement of adult ALL including approaches to rare entities and specific situations. It represents the result of a structured consensus process conducted by the members of the European Working Group for Adult ALL.
The book gives an overview on the current strategies for ma-nagement of adult ALL including approaches to rare entities and specific situations. It represents the result of a structured consensus process conducted by the members of the European Working Group for Adult ALL.
Inhaltsverzeichnis zu „Recommendations of the European Working Group for Adult ALL / UNI-MED Science (PDF)“
Contents 1. Approach to the Patient with a Suspect of ALL 24 1.1. Clinical diagnosis, required lab and other tests 24 1.2. Morphology and cytochemistry 24 1.3. Immunophenotyping 25 1.4. Cytogenetics 26 1.5. Molecular genetics 27 1.6. Gene expression profiling 28 1.7. Minimal residual disease 29 1.8. Organization of central diagnosis and cell banking 29 1.9. Most important differential diagnoses 29 2. Appropriate Setting for Management of ALL 34 2.1. Medical care 34 2.1.1. Appropriate facilities for acute leukemia patients 34 2.1.2. Management during induction therapy and during high dose therapy with or without SCT 34 2.1.3. Evaluation procedures of treatment 36 2.1.3.1. Induction therapy and high dose therapy with or without SCT 36 2.2. Psychological approach (assistance) of the patient and the family 36 2.3. Physical sustenance 36 2.4. What would a patient with ALL like to know 37 3. Prognostic Factors and Risk Adapted Therapy 40 3.1. Symptoms and clinical markers 40 3.2. Immunologic subgroups 40 3.3. Cytogenetics 41 3.4. Molecular genetics 41 3.5. Gene expression profiles 43 3.6. Pharmacogenetics 43 3.7. Others 44 3.8. Models for risk stratification 45 4. Supportive Care 54 4.1. General measures 54 4.2. Anti-emetics 54 4.3. Anti-infection prophylaxis 56 4.4. Transfusion policy 58 4.5. Growth factors 59 4.6. Menstruation prophylaxis and preservation of fertility 60 5. Treatment of ALL 66 5.1. Induction therapy 66 5.1.1. Risk stratification and definition of subgroups 66 5.1.2. Standard approach 66 5.1.3. Targeted therapy and future options 69 5.2. Consolidation therapy 73 5.2.1. Standard approach 73 5.2.2. Risk- and MRD-oriented approach 74 5.2.3. Integration with allogeneic SCT and autologous SCT 75 5.2.4. Pediatric-type regimens 76 5.3. CNS prophylaxis 79 5.3.1. CNS involvement at diagnosis 80 5.3.2. Risk factors for CNS relapse 80 5.3.3. Approaches for treatment and prophylaxis of CNS relapse 80 5.3.3.1. Intrathecal therapy 80 5.3.3.2. Combination approaches 81
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5.3.3.3. Cranial irradiation 81 5.3.4. Practical aspects 82 5.3.5. Potential neurotoxicities related to CNS-directed treatment or prophylaxis 82 5.4. Maintenance therapy 84 5.4.1. Standard maintenance 84 5.4.1.1. Current practice 84 5.4.1.2. Drugs for maintenance therapy 84 5.4.2. Role of intensification of maintenance 85 5.4.3. Maintenance therapy after autologous hematopoietic stem cell transplantation (autoHSCT) 86 5.4.4. MRD-evaluation for decision making 86 5.5. The management of extramedullary ALL 88 5.5.1. Incidence and site of extramedullary disease 88 5.5.2. Prognostic factors 88 5.5.3. Treatment strategies 88 5.5.3.1. CNS disease 88 5.5.3.2. Non-CNS extramedullary disease 90 5.5.4. Relapsed extramedullary disease 90 5.5.5. Role of transplant 91 5.6. Minimal residual disease 93 5.6.1. Methods for MRD evaluation 93 5.6.2. Standards and definitions 94 5.6.3. Prognostic relevance of MRD 95 5.6.4. MRD before and after Stem Cell Transplantation 96 5.6.5. Clinical application 97 5.6.6. European Consensus Project 98 5.7. Stem cell transplantation 101 5.7.1. Considerations for analysis of SCT results 101 5.7.2. Results of SCT 102 5.7.3. Comparisons of chemotherapy and SCT 104 5.7.4. Conditioning 104 5.7.5. Post-transplant monitoring and treatment 107 5.7.6. Prognostic factors for outcome of SCT 107 5.7.7. Indications for SCT 112 5.8. Philadelphia chromosome positive ALL (Ph+ ALL) 116 5.8.1. Clinical characteristics 116 5.8.2. Diagnosis 117 5.8.3. Treatment of Ph/BCR-ABL+ ALL: Imatinib and chemotherapy 117 5.8.4. CNS prophylaxis 120 5.8.5. Allogeneic stem cell transplantation (SCT) after imatinib-based therapy 120 5.8.6. Imatinib administration following SCT 121 5.8.7. Mechanisms of resistance to therapy and progression 121 5.8.8. Assessment of MRD 122 5.8.9. Treatment of relapse 123 5.8.10. Future treatment concepts 125 5.8.11. Conclusions 126 5.9. Burkitt lymphoma and leukemia 129 5.9.1. Patients without HIV infection 129 5.9.1.1. Diagnosis 129 5.9.1.2. Treatment concepts and results 133 5.9.1.3. Specific issues in supportive care 137 5.9.2. B-ALL/Burkitt's NHL in patients with HIV infection 140 5.9.2.1. Comparison of clinical-biologic characteristics with those from non HIV-infected patients 140 5.9.2.2. Therapeutic approach 140 5.10. Lymphoblastic lymphoma 142 5.10.1. Immunophenotype 142 5.10.2. Clinical features 142 5.10.3. Therapy 143 5.10.4. CNS prophylaxis 144 5.10.5. Management of mediastinal tumors 144 5.10.6. Prognostic factors 146 5.10.7. MRD in T-LBL 146 5.10.8. Stem cell transplantation in T-LBL 146 5.10.9. Treatment of relapse 148 5.11. ALL in adolescents and young adults 149 5.11.1. Clinical and biologic characteristics in adolescents and young adults 149 5.11.2. Pediatric-based vs adult-based treatments 150 5.11.3. Role of hematopoietic stem cell transplantation in ALL in adolescents and young adults 153 5.12. Elderly ALL 156 5.12.1. Age-related clinical and biological differences 156 5.12.2. Management of non-frail patients 157 5.12.3. Management of frail patients 162 5.13. ALL diagnosed in pregnant women 163 5.13.1. Incidence 163 5.13.2. Treatment approach and complications 164 5.13.3. Ph+ ALL 164 5.13.4. Supportive therapy 164 5.13.5. Timing of delivery 165 5.13.6. Fetal outcome and breastfeeding 165 5.14. ALL in Jehovah's Witness 166 6. Management of Ph- ALL Relapse / New Drugs in Ph- ALL 172 6.1. Outcome of adult patients with Ph- ALL in first relapse 172 6.2. Salvage chemotherapy studies 173 6.3. Post-transplant relapses 175 6.4. New drugs in Ph- ALL 175 6.4.1. New nucleoside analogs 175 6.4.2. New formulations of existing agents 176 6.4.3. Monoclonal antibodies 177 6.4.4. New antimetabolites 178 6.4.5. Targeted molecular therapies 178 6.5. Conclusion 178 7. Late Effects of Therapy 184 7.1. Definitions 184 7.2. Type of late effects in cured ALL patients 184 7.3. Late effects after stem cell transplantation 187 7.4. Late effect assessment in the GMALL studies 187 7.5. Quality of life in ALL patients 187 7.6. Patient advice and after-care 188 7.7. Summary 188 8. EWALL Consensus Definitions 194 9. European Study Groups for Adult ALL 204
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Bibliographische Angaben
- Autor: Nicola Gökbuget
- 2011, 1. Auflage, 207 Seiten, Englisch
- Verlag: Uni-Med Verlag Ag
- ISBN-10: 3837452999
- ISBN-13: 9783837452990
- Erscheinungsdatum: 31.07.2011
Abhängig von Bildschirmgröße und eingestellter Schriftgröße kann die Seitenzahl auf Ihrem Lesegerät variieren.
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