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Books > Medicine > Clinical & internal medicine > Haematology
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Acute Leukemias IV - Prognostic Factors and Treatment Strategies (Paperback, Softcover reprint of the original 1st ed. 1994)
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Acute Leukemias IV - Prognostic Factors and Treatment Strategies (Paperback, Softcover reprint of the original 1st ed. 1994)
Series: Haematology and Blood Transfusion Hamatologie und Bluttransfusion, 36
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The rates of acute leukemia cure have gradually improved over the
last decade. Clinical study results reflect the impact of
chemotherapy intensity and duration, the role of prolonged
maintenance, intensified consolidation or very early
intensification. Further progress has also been achieved in bone
marrow trans plantation, and recent prospective studies and
meta-analyses have contributed comparisons of the high antileukemic
efficacy of bone marrow transplantation to that of improved
chemotherapy. This allows a more successful combining of the two
forms of treatment. New prognostic factors have emerged from both
cytogenetic and molecular genetic research. Thus, the Philadelphia
chromosome translocation and the bcr/abl gene rearrangement have
proven to be the dominating risk factor in acute lymphoblastic
leukemia. Since the frequency increases with age, differences in
prognosis between children and adults can be explained. Evaluation
of molecular and immunologic leukemia cell markers has provided a
better understanding of residual leukemia in clinical remission, as
a prognostic factor and in monitoring the effectiveness of the
antileukemic strategy. Recent work on leukemic cell biology has
resulted in novel therapeutic approaches such as terminal
differentiation by all-trans-retinoic acid, modulation of
chemotherapy by hematopoietic growth factors such as GM-CSF and
enhancement of immunologic control by cytokines such as interleukin
2. New antimicrobial drugs and the application of mostly empiric
anti-infectious strategies have helped reducing the therapeutic
risk. Thus, a number of recent achievements have provided us with
new options in the management of patients with acute leukemias."
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