Abstracts of the 11th Euroconference on Clinical Cell Analysis. Dublin, Ireland, 14–17 September 2011
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 413 KB
- Volume
- 80B
- Category
- Article
- ISSN
- 1552-4949
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✦ Synopsis
Treatment of ALL in childhood is tailored to risk group, and a variety of clinical and laboratory factors play a major role in determining that risk. Simple factors including age and white count have for years been used to separate children into good and poor risk groups and assessment of a small number of genetic markers is also central to accurate risk grouping. However, in the last decade, it has become apparent that minimal residual disease (MRD) detected relatively early after initiating therapy, is among the strongest adverse prognostic factors. MRD can be detected either by polymerase chain reaction amplification of clone-specific rearrangements of the immunoglobulin or T cell receptor genes, or by flow cytometry. The former method is more sensitive, but the latter is faster and allows for rapid assessment of disease risk, and the potential for early intervention. By measuring MRD at the end of or even during induction therapy, it is possible to identify patients who might benefit from either intensification or deintensification of post-induction therapy, while identifying patients who persist with high levels of MRD even later in therapy might identify patients who might require investigational interventions or marrow transplantation. Combining MRD analysis with other factors used in classification provides more customized risk stratification. Still, in spite of these advances, there is heterogeneity in outcome of the best-defined risk groups; new markers, discovered via genome-wide screening, provide additional independent prognostic information and might in the future allow for more specific therapy for children with ALL.